P429 PROGNOSTIC IMPACT OF ROUTINE SIX–MONTH EXERCISE STRESS TEST AFTER COMPLEX LEFT MAIN BIFURCATION PCI

Abstract

Abstract Background/Aim The prognostic value of the exercise stress after complex stenting of left main (LM) coronary artery bifurcations (LM) disease has been poorly investigated in the modern era. Methods We retrospectively analysed the procedural and medical data of patients referred to our center for complex LM bifurcation diseas, treated using either single versus dual stenting [Cross–over provisional stenting, T or T–and–Protrusion (TAP), Culotte, and Nano–inverted–T (NIT)] techniques between January 2008 to May 2018. The prognostic impact of an exercise test performed at 6 months during the follow–up period. Results Five hundred and two patients (316 males, mean age 70.3±12.8 years, mean Syntax score 31.6±6.3) were evaluated. At a mean follow–up of 37.1±10.8 months (range 22.1–47.3 moths), Target lesion failure (TLF) rate was 10.1%. Stent thrombosis and cardiovascular mortality were observed in 1.2% and 3.6% of cases, respectively. A positive exercise test at 6 months of follow–up was detected in 42 out of 502 patients (8.4%) and correlated with angiographic restenosis in 38 patients (7.6%): 7/171patients in Cross–over group (4.1%), 10/61 patients in T or TAP group (16.4%), 15/98 patients in Culotte group (15.3%) and 6/172 patients in NIT group (3.5%). Multivariate Cox regression analysis demonstrated that Age > 75 years (HR 1.45, 95% CI: 1.33–1.58, p = 0.03), dyslipidaemia (HR: 1.68, 95% CI: 1.58–1.72, p < 0.001), eGFR<30 ml/min/1.73 m2 (HR: 1.44, 95% CI: 1.38–1.52, p = 0.04), presence of a triple vessel disease (HR: 1.89, 95% CI: 1.89, 95% CI: 1.84–1.93, p < 0.001), additional ostial LM lesion (HR: 1.75, 95% CI: 1.76–1.81, p < 0.001), additional LM body lesion (HR: 1.33, 95% CI: 1.28–1.36, o < 0.001), a Syntax score > 25 (HR:1.67, 95% CI: 1.61–1.76, p = 0.01), need of Rotablator (HR: 1.66, 95% CI: 1.61–1.75, p = 0.02) and the number of stents implanted (HR: 1.12, 95% CI: 1.08–1.16, p < 0.001) were independent predictors of a positive stress test. Patients reporting a negative exercise test at 6 months of follow–us had a higher freedom from TLF and improved survival compared to those with positive exercise stress test (Figure 1 Panels A and B). Conclusions A negative exercise performed after 6 months from complex left main stenting predicted excellent outcomes at 3 years follow–up.