Results of percutaneous treatment of the left main coronary artery in elderly patients

Abstract

Abstract Introduction and objectives Surgical revascularization of the left main (LM) coronary lesions has been the most accepted strategy. However, elderly and frailty patients are not represented in the specific trials that compared surgical versus percutaneous revascularization. Conservative treatment does not seem to be a feasible option due to high major cardiac adverse event rate at short term follow-up. The objective of the study was to analyze the results of percutaneous treatment of the LM in elderly patients who were not candidates for surgical revascularization due to high surgical risk or medical decision. Methods We performed an unicentric, retrospective and descriptive study. We included patients aged 75 years or older who presented with an LM lesion (isolated or associated with other coronary lesions) between between 2017 and 2021 underwent percutaneous treatment. Results During this time period, a total of 140 patients who met the inclusion criteria were treated in our center. The mean age was 81±4 years and 64% (89 patients) were male. Acute coronary syndrome was the clinical presentation in 59% of patients. Seventy-five patients (54%) met criteria of frailty or high comorbidity. The use of nonsteroidal anti-inflammatory drugs were predominated risk factor associated (94 patients, 67%). Immediate success of the procedure was obtained in 97%, with an in-hospital mortality of 7%. The remaining variables are described in Figure 1. With a median follow-up of 19 months, 29 adverse cardiac events (20%) were recorded: 3 (2%) patients suffered a nonfatal myocardial infarction, 7 (5%) patients required a new revascularization, and 19 (14%) patients died of cardiac causes. However, up to 11% (15 patients) died of non-cardiac causes at follow-up (Figure 1 and 2a). A non-significant trend was found for a worse prognosis in terms of survival in frail patients (HR: 1.6 (0.76–3.3), p: 0.212) (Figure 2b). Conclusions Percutaneous treatment of left main coronary artery in elderly patients with multiple associated comorbidities could be considered a feasible option in this special population. The rate of cardiac events at follow-up seems acceptable. Funding Acknowledgement Type of funding sources: None.