Long-Term Outcomes After Percutaneous Coronary Intervention (PCI) to an Unprotected Left Main Coronary Artery (LMCA) in Cardiogenic Shock: Observations From the Melbourne Interventional Group (MIG) Registry

Abstract

Background: Recent trials support the use of PCI with drug eluting stents as an alternative to coronary artery bypass grafting (CABG) in selected stable patients. In cardiogenic shock, urgent revascularisation is optimal. We review the MIG experience on unprotected LMCA PCI in cardiogenic shock. Method: Excluding patients with previous bypass surgery, consecutive patients presenting with cardiogenic shock undergoing PCI from the MIG registry between 2005-2016 were analysed, comparing those with LMCA PCI to non-LMCA PCI. Results: A total of 601 patients (3.2% of all PCI patients without previous CABG) presented in cardiogenic shock. 45 (7.5%) patients had unprotected LMCA PCI. Patients undergoing unprotected LMCA PCI were older (70.1years vs 65.8years, p = 0.01) with the same rate of male predominance (77.8% vs 72.1%, p = 0.75), hypertension (70.5% vs 56.8%, p = 0.08), diabetes (22.7% vs 24.6%, p = 0.78) and hypercholesterolaemia (52.3% vs 47.1%, p = 0.51). In cardiogenic shock, the in hospital mortality with unprotected LMCA PCI is 64.4% compared to 36.5% with non LMCA PCI, with long-term mortality linked to the national death index (NDI) in the LMCA PCI group being 80.0%. Unprotected LMCA PCI in the setting of cardiogenic shock is an independent predictor of long-term mortality (HR 1.59, 95% CI 1.003-2.527, p = 0.048). Conclusion: Outcomes after PCI to unprotected LMCA in cardiogenic shock are poor, with the excess in mortality occurring early. It may be beneficial for on table discussions regarding urgent coronary bypass grafting in this setting.