Residual Right Coronary Artery Stenosis after Left Main Coronary Artery Intervention Increased the 30-Day Cardiovascular Death and 3-Year Right Coronary Artery Revascularization Rate.

Chien-Ho Lee,Shu-Kai Hsueh,Cheng-I Cheng,Wen-Jung Chung,Shaur-Zheng Chong

doi:10.1155/2020/4587414

Chien-Ho Lee, Shu-Kai Hsueh + Show 3 more

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https://doi.org/10.1155/2020/4587414

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Abstract

Background The outcomes of patients with concomitant left main coronary artery (LMCA) and right coronary artery (RCA) diseases are reportedly worse than those with only LMCA disease. To date, only few studies have investigated the clinical impact of percutaneous coronary intervention (PCI) on RCA stenosis during the same hospitalization, in which LMCA disease was treated. This study was aimed at comparing the outcomes between patients with and without right coronary artery intervention during the same hospital course for LMCA intervention. Methods and Results From a total of 776 patients who were undergoing PCI to treat LMCA disease, 235 patients with concomitant RCA significant stenosis (more than 70% stenosis) were enrolled. The patients were divided into two groups: 174 patients received concomitant PCI for RCA stenosis during the same hospitalization, in which LMCA disease was treated, and 61 patients did not receive PCI for RCA stenosis. Patients without intervention to the right coronary artery had higher 30-day cardiovascular mortality rates and 3-year RCA revascularization rates compared to those with right coronary artery intervention. Patients without RCA intervention at the same hospitalization did not increase the 30-day total death, 3-year myocardial infarction rate, 3-year cardiovascular death, and 3-year total death. Conclusions In patients with LM disease and concomitant above or equal to 70% RCA stenosis, PCI for RCA lesion during the same hospitalization is recommended to reduce the 30-day cardiovascular death and 3-year RCA revascularization rate.

Highlights

With recent significant advancement in devices and techniques used for percutaneous coronary intervention (PCI), unprotected left main (LM) coronary artery disease (CAD) can be safely and effectively managed
Patients with acute ST-elevation myocardial infarction (STEMI), RCA stenosis less than 70%, or RCA with chronic total occlusion (CTO) were excluded in this study
Discussion is study provides evidence that PCI for concomitant RCA stenosis with LM intervention during the same hospitalization significantly lowers the 30-day cardiovascular death and 3-years RCA revascularization rate compared to patients who do not receive PCI for RCA stenosis

Summary

Introduction

With recent significant advancement in devices and techniques used for percutaneous coronary intervention (PCI), unprotected left main (LM) coronary artery disease (CAD) can be safely and effectively managed. In a recent meta-analysis, PCI to left main disease had the same all-cause mortality versus the CABG intervention [3]. The patients with concomitant LM and RCA disease had higher cardiac death after PCI to the left main disease than those without RCA disease (17.7% vs 6.7%, p 0.056), and the patient with chronic total occlusion (CTO) of the right coronary artery had extreme high mortality (30% vs 6.7%, p 0.015) [4]. Residual CTO of the RCA is the predictor of mortality for patients who undergo PCI to unprotected left main disease [5, 6]. Current ACC/AHA guideline recommends PCI to the noninfarct vessel in selected patients with STEMI, and ESC guideline recommends revascularization of the noninfarctrelated artery in patients with ST-segment elevation

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Conclusion