Percutaneous left main coronary disease treatment without on-site surgery back-up in patients with acute coronary syndromes: immediate and 2-year outcomes

Andrea Gagnor, Francesco Tomassini, Enrico Romagnoli, Vincenzo Infantino, Maria Cristina Rosa Brusin, Cristina Maria, Rosario Tripodi, Giuseppe Sangiorgi, Ferdinando Varbella
Catheterization and Cardiovascular Interventions 2012 May 1, 79 (6): 979-87

BACKGROUND: Best revascularization strategy in patients with acute coronary syndromes (ACS) and unprotected left main (ULM) coronary disease is still debate reflecting lack of convincing data.

OBJECTIVES: To assess clinical feasibility and efficacy of ULM percutaneous coronary intervention (PCI) in patients with ACS and describe the practice of a center without on-site surgical back-up over a 7-year period.

METHODS: Data on high-risk patients with ACSs undergoing percutaneous ULM treatment were prospectively collected in an independent registry. Primary end-points of this study were immediate and long-term outcomes expressed as target lesion failure (TLF, composite of cardiac death, myocardial infarction (MI), and target lesion revascularization).

RESULTS: Between January 2003 and January 2010, 200 consecutive patients were included in this study. Angiographic success was obtained in 95% of patients but procedural success was 87% primarily affected by an 11% of in-hospital cardiac mortality. At median follow-up of 26 months (IQ 10-47), the overall TLF rate was 28.5%, with 16.0% of cardiac death, 7.0% of MI, and 10.5% of clinically driven target lesion revascularization rates. Cumulative definite/probable stent thrombosis was 3.5%. Elevated EuroSCORE value and pre-procedural hemodynamic instability were the strongest predictors of TLF. Temporal trend analysis showed progressive but not significant improvement for both immediate (P = 0.110) and long-term (P = 0.073) outcomes over the study period.

CONCLUSIONS: This single-center study based on current clinical practice in patient with ULM disease and ACS confirmed PCI as feasible revascularization strategy in absence of on-site cardio-thoracic support. Nevertheless, the outcome of these high-risk patients is still hampered by a sensible in-hospital mortality rate.

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