Abstract
Objectives We aim to evaluate long-term outcomes after left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). Background PCI of the LMCA has been an acceptable revascularization strategy in stable coronary artery disease. However, limited studies on long-term clinical outcomes of LMCA PCI in ACS patients are available. Methods A total of 6429 consecutive patients with ACS undergoing PCI in Fuwai Hospital in 2013 were enrolled. Patients are divided into LMCA group and Non-LMCA group according to whether the target lesion was located in LMCA. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results 155 (2.4%) patients had target lesion in LMCA, while 6274 (97.6%) patients belong to the non-LMCA group. Compared with non-LMCA patients, LMCA patients have generally more comorbidities and worse baseline conditions. Two-year follow-up reveals that LMCA patients have significantly higher rate of cardiac death (2.6% vs. 0.7%, p = 0.034), myocardial infarction (7.1% vs. 1.8%, p < 0.001), in-stent thrombosis (4.5% vs. 0.8%, p < 0.001), and stroke (7.1% vs. 6.4%, p = 0.025). After adjusting for confounding factors, LMCA remains independently associated with higher 2-year myocardial infarction rate (HR = 2.585, 95% CI = 1.243–5.347, p = 0.011). Conclusion LMCA-targeted PCI is an independent risk factor for 2-year myocardial infarction in ACS patients.
Highlights
For patients with low SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score, percutaneous coronary intervention (PCI) has been recommended as a reasonable revascularization strategy in patients with significant stenosis in the left main coronary artery (LMCA) presenting with stable coronary artery disease (SCAD) [1]
Among 6,429 patients presenting with acute coronary syndrome (ACS) undergoing PCI, 155 (2.4%) patients was in the LMCA group, while 6,274 (97.4%) patients belonged to the non-LMCA group
Before propensity score match (PSM) and after adjusting for differences by Cox regression analysis in age, diabetes, hemoglobin and glomerular filtration rate (GFR) levels, clinical presentation, preprocedural SYNTAX score, puncture site, staged PCI, intravascular ultrasound (IVUS) and intraaortic balloon pump (IABP) usage, successful PCI, and stent type, we found LMCA was independently associated with higher risk of 2-year myocardial infarction (MI) (HR 2.585, 95% confidence intervals (CI) 1.243–5.347, p 0.011) and in-stent thrombosis (HR 2.888, 95% CI 1.101–7.576, p 0.031)
Summary
For patients with low SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score, percutaneous coronary intervention (PCI) has been recommended as a reasonable revascularization strategy in patients with significant stenosis in the left main coronary artery (LMCA) presenting with stable coronary artery disease (SCAD) [1]. Previous studies have proven that, compared with coronary artery bypass graft (CABG) surgeries, unprotected LMCA-targeted PCI resulted in similar rate of mortality and composite event of death, myocardial infarction (MI), and stroke [2,3,4,5,6,7,8,9,10]. Studies on long-term clinical outcomes of LMCA PCI in acute coronary syndrome (ACS) patients are relatively rare. In another study reported by Gao et al [14], transradial PCI on unprotected LMCA and/or multivessel disease for patients with ACS had comparable clinical outcomes to CABG, with an advantage of reducing stroke. A recent analysis from the EXCEL trial has found that patients with LMCA disease
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