Unprotected Left-Main Coronary Angioplasty in the Elderly in a High Volume Catheterization Centre without On-Site Surgery Facilities: Immediate and Medium Term Outcome—The Old-Placet Registry

A Gagnor,S Giolitto,E Tizzani,M Bollati,F Varbella,E Cerrato,F Tomassini,E Favro,A Gambino,C Rolfo

doi:10.1155/2015/751293

Abstract

We aim to assess clinical feasibility and efficacy of unprotected left main (ULM) percutaneous coronary intervention (PCI) in patients older than 75 years over a 6-year period and with 2-year follow-up demonstrating that PCI is a feasible revascularization strategy even in absence of on-site cardiothoracic support. Nevertheless, the outcome of these high-risk patients is still hampered by a sensible in-hospital mortality rate. Older patients have a higher mortality at follow-up (10.0 versus 0.8%, P = 0.014), while younger patients have a low mortality after the acute phase (15.7 versus 8.4%, P = 0.15).

Highlights

Unprotected left main (ULM) coronary disease incidence during diagnostic coronary angiography ranges between 4 and 7% [1] and increases with age [2, 3]
We evaluated the feasibility and the efficacy of percutaneous ULM coronary disease treatment in older population in a group of patients referred to a centre without onsite cardiothoracic surgical support in the contest of acute coronary syndrome (ACS)
The high-risk profile of this cohort includes acute Myocardial infarction (MI) diagnosis in 34.5% with 22% with ST-elevation myocardial infarction (STEMI) presentation, multivessel coronary artery disease (CAD) in 63.0%, severely depressed ejection fraction (EF) (

Summary

Introduction

Unprotected left main (ULM) coronary disease incidence during diagnostic coronary angiography ranges between 4 and 7% [1] and increases with age [2, 3]. Even recent guidelines [4] consider coronary artery bypass graft (CABG) the preferred revascularization strategy for ULM disease, especially when distal bifurcation is involved and in presence of diffuse multivessel coronary disease [5]. We evaluated the feasibility and the efficacy of percutaneous ULM coronary disease treatment in older population (more than 75 years old) in a group of patients referred to a centre without onsite cardiothoracic surgical support in the contest of acute coronary syndrome (ACS)

Objectives

Methods

Results

Discussion

Conclusion