Unprotected Left Main Intervention Research Articles

Long-term outcome of diabetic patients after unprotected left main percutaneous coronary interventions

Abstract Background Diabetes mellitus (DM) represents an elevated risk in terms of percutaneous coronary intervention (PCI), especially in patients with significant left main (LM) disease. Purpose Our aims were to investigate the 60-month mortality and event-free survival of consecutive patients with DM undergoing unprotected LM PCI at our centre and sought to determine the independent predictors of event-free survival. Methods We included all patients undergoing unprotected LM PCI at our tertiary care centre between 1 January 2007 and 31 December 2014. The primary endpoint was the composite of all-cause mortality, myocardial infarction, and target lesion revascularization at 60 months. Survival curves were constructed using the Kaplan-Meier non-parametric estimator. ROC analysis was used to investigate the predictive power of conventional risk scores (SYNTAX, SYNTAX II, EuroSCORE II, additive and logistic EuroSCORE, ACEF, GRACE 2). Independent predictors were determined by univariate and multivariate analysis. Results A total of 513 patients (mean age 68 ± 12 years, 64% male) underwent unprotected LM PCI during this period, among these 310 (60%) were non-diabetic (non-DM) and 203 (40%) were diabetic (DM). In terms of indication, 157 (31%) elective and 356 (69%) acute LM PCI were performed. There was no significant difference between the non-DM and DM groups in terms of acute indication (218 (70%) vs. 138 (68%), p=0.574). Within the DM group, 135 (67%) were treated with oral antidiabetics (OAD) and 68 (33%) were treated with insulin (IDM). The mean survival (34.6 vs. 39.7 vs. 43.1 months, p=0.003) and event-free survival (29.3 vs. 34.7 vs. 39.3 months, p=0.001) were significantly lower in the IDM and OAD groups compared to non-DM, respectively. Of the risk scores, the SYNTAX score was the most predictive in diabetic patients (AUC=0.767). Based on the SYNTAX score, diabetic patients with a low SYNTAX score (<23) had less events (59% vs. 66%, p=0.043) than those having a moderate/high SYNTAX score (≥23). LVEF (HR 0.976; 95% CI, 0.965-0.987, p<0.001), right coronary artery occlusion (HR 2.031; 95% CI, 1.346-3.064, p=0.001), acute coronary syndrome (HR 1.861; 95% CI, 1.252-2.767, p=0.002), use of FFR (HR 0.481; 95% CI, 0.265-0.871, p=0.016), true bifurcation lesion (HR 1.559; 95% CI, 1.068-2.277, p=0.021) and newer DES generation (HR 0.706; 95% CI, 0.568-0.877, p=0.002) were predictors of event-free survival in diabetics by univariate analysis. Glomerular filtration rate (HR 0.982; 95% CI, 0.973-0.991, p<0.001) emerged as an independent predictor according to multivariate analysis. Conclusion Consecutive diabetic patients with significant unprotected LM stenosis have poor long-term outcome after LM PCI. Anatomical complexity of the lesions is a significant predictor of event-free survival. Careful intervention planning and the use of appropriate tools can improve the outcome in this high-risk population.

TCT-562 Long-term Outcome of Diabetic Patients After Unprotected Left Main Percutaneous Coronary Interventions

TCT-562 Long-term Outcome of Diabetic Patients After Unprotected Left Main Percutaneous Coronary Interventions

Long-term outcome after unprotected left main percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock: a landmark analysis

Abstract Funding Acknowledgements None. Background Early revascularization of culprit arteries has demonstrated to improve outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS), however, little is known about long-term outcome after unprotected left main (LM) percutaneous coronary intervention (PCI) in patients with AMI-CS. Methods We retrospectively investigated 2325 consecutive patients with AMI who underwent primary percutaneous coronary intervention (pPCI) in our institution from January 2004 to December 2017. The primary outcome was cardiovascular (CV) death up to 3yrs. Results Among the 2325 eligible patients, 272 AMI patients (11.7%) were complicated by CS on admission (AMI-CS). The mean age was 71 years, 75% of patients were male, STEMI was seen in 86%, and mechanical circulatory support was used in 61%. Of 272 AMI-CS, 35 (14.0%) patients were treated with PCI for LM and had significantly higher 30-day cardiovascular mortality (52.6%) compared with those treated with PCI for non-LM (24.8%) (p = 0.0001). Kaplan-Meier analysis showed that mortality up to 3 years was significantly higher in AMI-CS patients with LM compared those with non-LM (p < 0.0001). Multivariate Cox regression analysis showed LM was significantly associated with higher cardiovascular mortality (adjusted HR 1.90, 95%CI 1.18-3.07, p = 0.0088). Conclusions Primary PCI of the LM was performed in 14.0% of patients with AMI-CS. Short- and long-term CV mortality was significantly higher with LM AMI-CS than non-LM AMI-CS. Further studies should evaluate to improve both short- and long-term outcome among AMI-CS with LM.

Impact of Polyvascular Disease in Patients Undergoing Unprotected Left Main Percutaneous Coronary Intervention

Percutaneous coronary intervention (PCI) has demonstrated its safety and efficacy in treating left main coronary artery disease (LM-CAD) in select patients. Polyvascular disease (PolyVD) is associated with adverse events in all-comers with CAD. However, there is little data examining the interplay between PolyVD and LM-PCI, which we sought to investigate in a retrospective single-center study. We included patients undergoing unprotected LM-PCI at a tertiary center from 2012-2019. The patient population was stratified based on the presence or absence of PolyVD (i.e. medical history of cerebrovascular and/or peripheral artery disease in addition to LM-CAD). The primary outcome was major adverse cardiovascular events (MACE) combining all-cause mortality and spontaneous myocardial infarction within one year after index PCI. Overall, 869 patients were included, and 23.8% of the population had PolyVD. Individuals with PolyVD were older and had a greater burden of comorbidities. After 1 year follow-up individuals with PolyVD exhibited significantly higher rates of both MACE (22.8% vs. 9.4%; p<0.001) and bleeding events compared to those without PolyVD. MACE was primarily driven by an increase in all-cause mortality (18.3% vs. 7.1%; p<0.001). Results persisted after adjusting for confounders. In conclusion, among patients undergoing LM-PCI, the presence of PolyVD is linked to an increased risk of MACE and bleeding after 1 year of follow-up, which highlights the vulnerability of this patient population.

Real-World Experience and Outcomes With Percutaneous Coronary Intervention for Protected Versus Unprotected Left Main Coronary Artery Disease: Insights from the Veteran Affairs Clinical Assessment Reporting and Tracking Program

Practice patterns and outcomes of protected left main (PLM) and unprotected left main (ULM) percutaneous coronary intervention (PCI) are not well defined in contemporary US clinical practice. Data collected from all Veteran Affairs (VA) catheterization laboratories participating in the Clinical Assessment Reporting and Tracking Program between 2009 and 2019. The analysis included 4,351 patients undergoing left main PCI, of which 1,306 pairs of PLM and ULM PCI were included in a propensity matched cohort. Selected temporal trends were also assessed. The primary outcome was MACE outcomes at 1-year, which was defined as a composite of all-cause mortality, rehospitalization for myocardial infarction (MI), rehospitalization for stroke or urgent revascularization. ULM PCI patients in comparison to PLM PCI were older (71.5 vs 69.2; P < 0.001), more clinically complex and more likely to present with ACS. In the propensity matched cohort, radial access was used more often for ULM PCI (21% [273] vs. 14% [185], P < 0.001), and ULM PCI was more likely to involve the LM bifurcation (22% vs 14%; P = 0.003) and require mechanical circulatory support (10% [134] vs 1% [17]; P <0.001). One-year MACE occurred more frequently with ULM PCI compared to PLM PCI (22% [289] vs. 16% [215]; P = < 0.001) and all-cause mortality was also higher (16% [213] vs. 10% [125]; P = < 0.001). In the matched cohort there was a low incidence of rehospitalization for MI (4% [48] ULM vs. 4% [48] PLM; P = 1.000) or revascularization (7% [94] ULM vs. 6% [84] PLM; P = 0.485). In this real-world experience patients undergoing PLM PCI had better one-year outcomes than those undergoing ULM PCI, but in both groups there was a high rate of mortality and MACE at one-year despite a relatively low rate of MI or revascularization.•What is known?○In contemporary practice, the use of percutaneous coronary intervention (PCI) for left main coronary artery disease has increased.○Clinical trials have demonstrated that left main PCI can be performed safely, but observational studies have shown that patients who undergo left main PCI are older and with more co-morbid conditions than trial populations.•What the study adds?○In a large multi-center sample from the United States Department of Veterans Affairs, there has been increasing use of left main PCI in patients who have not undergone prior coronary artery bypass graft surgery (CABG).○Compared to patients with prior CABG who underwent left main PCI, those who underwent left main PCI without prior CABG had a higher rate of major adverse cardiovascular events and all cause death at 12 months.○While there was an overall low rate of rehospitalization for myocardial infarction or revascularization, there was a higher 12-month incidence of major adverse cardiovascular events in this real-world population compared to clinical trial populations.

A New Scoring System Predicting Side-Branch Occlusion in Patients Undergoing Left Main Bifurcation Intervention: The LM V-RESOLVE Score

BackgroundThe risk of side-branch (SB) occlusion is pivotal for decision making of stenting strategies during unprotected left main (LM) bifurcation percutaneous coronary intervention (PCI). Accordingly, this study aimed to develop a scoring system for predicting SB occlusion during unprotected LM bifurcation PCI. MethodsA total of 855 consecutive patients undergoing unprotected LM bifurcation PCI with provisional strategy at Fuwai Hospital from January 2014 to December 2016 were recruited. A prediction model was selected by means of all-subsets logistic regression, and a multivariable risk score (Left Main Visual Estimation for Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention [LM V-RESOLVE]) was then established with incremental weights attributed to each component variable based on its estimate coefficients. SB occlusion was defined as any decrease in Thrombolysis in Myocardial Infarction (TIMI) flow grade or absence of flow in SB after main vessel (MV) stenting. ResultsSB occlusion occurred in 19 LM bifurcation lesions (2.22%). In multivariable model, 3 variables, including MV/SB diameter ratio, MV plaque ipsilateral to SB, and baseline diameter stenosis of SB, were independent predictors for SB occlusion (model C-statistic 0.829, 95% confidence interval [CI] 0.735-0.923, with good calibration). The risk score had a C-statistics of 0.830 (95% CI 0.738-0.923) with good calibration. Satisfactory discriminative ability of the risk score was also preserved in external validation (C-statistic 0.794, 95% CI 0.691-0.896). ConclusionsThe LM bifurcation–specific novel scoring system, LM V-RESOLVE, based on 3 simple baseline angiographic findings, could help to rapidly discriminate lesions at risk of SB occlusion during LM bifurcation PCI.

TCT-511 Impact of Adjunctive Intravascular Imaging on Cardiovascular Outcomes in Unprotected Left Main Percutaneous Coronary Intervention at a High-Volume Center

TCT-511 Impact of Adjunctive Intravascular Imaging on Cardiovascular Outcomes in Unprotected Left Main Percutaneous Coronary Intervention at a High-Volume Center

TCT-509 Impact of Coronary Trifurcation Anatomy on Cardiovascular Outcomes in Unprotected Left Main Percutaneous Coronary Intervention.

TCT-509 Impact of Coronary Trifurcation Anatomy on Cardiovascular Outcomes in Unprotected Left Main Percutaneous Coronary Intervention.

Applicability of the EXCEL Trial Criteria to an All-Comers Real-World Cohort of Unprotected Left Main Percutaneous Coronary Intervention

The Evaluation of XIENCE versus EXCEL (Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial is the largest randomized study comparing percutaneous coronary intervention (PCI) with second-generation drug-eluting stents and bypass surgery in unprotected left main disease (ULMD). Our aim was to assess which proportion of patients from a contemporary all-comer population of ULMD PCI would be eligible for the EXCEL trial and whether these patients show different long-term outcomes than the rest of the ULMD population. A total of 246 consecutive patients underwent ULMD PCI between January 2018 and December 2021 and were retrospectively analyzed. After application of the EXCEL trial inclusion and exclusion criteria, 98 patients (39%) were allocated to the "EXCEL-like" cohort and 148 to the "non-EXCEL-like." Baseline characteristics of the 2 groups were substantially comparable. The mean baseline SYNTAX score was lower in the EXCEL-like patients than the non-EXCEL-like group (20.1 ± 7.1 vs 23.0 ± 11.2, p=0.025), with the latter also showing a higher degree of incomplete revascularization (residual SYNTAX score >8:11% vs 26%, p=0.005). At 1year, the cumulative major adverse cardiovascular and cerebral events rate was 7% for the EXCEL-like and 17% for the non-EXCEL-like patients, respectively (p=0.03). At the last follow-up available, the significant difference in major adverse cardiovascular and cerebral events rate persisted (19% vs 37%, p=0.02) and a significant difference in any unplanned revascularization was also shown (1.5% vs 13%, p=0.04). In conclusion, in a contemporary real-world cohort of ULMD PCI, only a minority of patients could be enrolled in the EXCEL trial; the EXCEL-like patients, in our population, showed less clinical events at long-term follow-up than the cohort of patients who were ineligible for EXCEL, despite comparable baseline cardiovascular profiles; these findings may challenge a broad external applicability of the results of the EXCEL trial in routine clinical activity.

Temporal Trends in In-Hospital Outcomes Following Unprotected Left-Main Percutaneous Coronary Intervention: An Analysis of 14 522 Cases From British Cardiovascular Intervention Society Database 2009 to 2017

Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main stem artery (unprotected left main stem percutaneous intervention) disease. However, whether patient outcomes have improved over time is uncertain. Using the United Kingdom national PCI database, we studied all patients undergoing unprotected left main stem percutaneous intervention between 2009 and 2017. We excluded patients who presented with ST-segment-elevation, cardiogenic shock, and with an emergency indication for PCI. Between 2009 and 2017, in the study-indicated population, 14 522 unprotected left main stem percutaneous intervention procedures were performed. Significant temporal changes in baseline demographics were observed with increasing patient age and comorbid burden. Procedural complexity increased over time, with the number of vessels treated, bifurcation PCI, number of stents used, and use of intravascular imaging and rotational atherectomy increased significantly through the study period. After adjustment for baseline differences, there were significant temporal reductions in the occurrence of peri-procedural myocardial infarction (P<0.001 for trend), in-hospital major adverse cardiac or cerebrovascular events (P<0.001 for trend), and acute procedural complications (P<0.001 for trend). In multivariable analysis examining the associates of in-hospital major adverse cardiac or cerebrovascular events, while age per year (odds ratio, 1.02 [95% CIs, 1.01-1.03]), female sex (odds ratio, 1.47 [1.19-1.82]), 3 or more stents (odds ratio, 1.67 [05% [1.02-2.67]), and patient comorbidity were associated with higher rates of in-hospital major adverse cardiac or cerebrovascular events, by contrast use of intravascular imaging (odds ratio, 0.56 [0.45-0.70]), and year of PCI (odds ratio, 0.63 [0.46-0.87]) were associated with lower rates of in-hospital major adverse cardiac or cerebrovascular events. Despite trends for increased patient and procedural complexity, in-hospital patient outcomes have improved after unprotected left main stem percutaneous intervention over time.

One Versus Two Stents Strategies for Unprotected Left Main Intervention: Gulf Left Main Registry.

The optimal stenting strategy for unprotected left main coronary artery (ULMCA) disease remains debated. This retrospective observational study (Gulf Left Main Registry) analyzed the outcomes of 1 vs 2 stents in patients with unprotected left main percutaneous coronary intervention (PCI). Overall, 1222 patients were evaluated; 173 had 1 stent and 1049 had 2 stents. The 2-stent group was older with more comorbidities, higher mean SYNTAX scores, and more distal bifurcation lesions. In the 1-stent group, in-hospital events were significant for major bleeding, and better mean creatinine clearance. At median follow-up of 20months, the 1-stent group was more likely to have target lesion revascularization (TLR). Total mortality was numerically lower in the 1-stent group (.00% vs 2.10%); however, this was not statistically significant (P=.068). Our analysis demonstrates the benefits of a 2-stent approach for ULMCA patients with high SYNTAX scores and lesions in both major side branches, while the potential benefit of a 1-stent approach for less complex ULMCA was also observed. Further studies with longer follow-up are needed to definitively demonstrate the optimal approach.

Left Ventricular Support for Unprotected Left Main Coronary Artery Interventions (The Dayton Heart and Vascular Impella Registry).

Coronary artery bypass grafting is the standard of care for patients with obstructive left main (LM) coronary disease. In poor surgical candidates, high-risk percutaneous coronary artery intervention (PCI) is an alternative. We investigated a retrospective cohort of patients who underwent LM PCI from January 2010 to March 2014 (n = 89). Obstructive LM disease was defined as 50% angiographic obstruction of luminal flow, and the primary endpoint was inhospital mortality. Ventricular assist device (VAD) was defined as the use of either intra-aortic balloon pump (IABP) or Impella 2.5 devices before, during, or following PCI. A total of 89 patients with LM PCI were divided into those with (n = 39) and without (n = 50) VAD support. The former group was further divided into those with support from either Impella 2.5 (n = 28) or IABP (n = 11). Age, race, and gender did not differ between patients who received unassisted LM-PCI from those with VAD support (P = 0.142, 1.0, and 0.776, respectively). The angiographic stenosis of atherosclerotic lesions in LM, proximal left anterior descending artery, and other native/surgical coronary vessels was similar between the groups. The duration of hospitalization was significantly longer for patients with VAD support compared to those without (7.19 ± 6.89 vs. 2.78 ± 3.39, P < 0.001). The incidence of cardiogenic shock and inhospital mortality was significantly higher in the VAD group (P = 0.009 and 0.001, respectively). Overall, inhospital mortality was 9% (8/89). The IABP and Impella 2.5 groups had mortality proportions of 46% (5/11) and 11% (3/28), respectively; P = 0.028. For all patients, inhospital mortality was higher for those with versus without cardiogenic shock (56% or 5/9 vs. 4% or 3/80; P < 0.001), and for those with versus without left ventricular systolic function <40% (17% vs. 2%;P < 0.025). In a selected group of patients with LM disease, unsupported PCI appears to be a feasible and safe procedure. In high-risk patients, the use of Impella 2.5 appears to be superior to IABP in LM PCI resulting in favorable short-term outcomes.

Intravascular imaging and drug-coated balloons forunprotected left main percutaneous coronary interventions: Questions with a predictable or unpredictable answer? Author's reply.

Intravascular imaging and drug-coated balloons forunprotected left main percutaneous coronary interventions: Questions with a predictable or unpredictable answer? Author's reply.

Clinical Case of Unprotected Left Main Percutaneous Coronary Intervention in Elderly Patient With Porcelain Aorta

Coronary artery bypass grafting (CABG) has long been considered the gold standard in the treatment of patients with lesions of the left main (LM) coronary artery. Elderly patients are one of the most difficult categories of patients with LM lesions due to severe coronary artery calcification. Thanks to constant progress in the field of engineering and technology, it has become possible to perform percutaneous coronary interventions (PCI) for patients with unprotected stenosis of the LM. Drug-eluting stents and the development of pharmacotherapy have improved the results of PCI in these lesions. Comparative studies of the efficacy and safety of PCI and CABG have shown similar results in terms of the need for revascularization. Patients with severe calcification of the coronary arteries mostly belong to the older age group and hold large part in this cohort. Technological advances enabled to treat patients with complex coronary anatomy and LM lesions not only through CABG, but also through PCI. Comparative studies show that the efficacy and safety of PCI and CABG have similar results in terms of the need in revascularization.&#x0D; The aim. To highlight the importance of discussion of each clinical case by the heart team and comprehensive approach with the use of modern equipment.&#x0D; Stage 1. A 80-year-old woman with type 2 diabetes mellitus was delivered by an ambulance team to the National Amosov Institute of Cardiovascular Surgery with severe pain; the patient was diagnosed with non-ST-elevation myocardial infarction (NSTEMI). Electrocardiography revealed ST-segment depression in leads V1-V5. After performing echocardiographic examination, valvular pathology and segmental contraction defects were not detected, EF 52%.&#x0D; Urgent coronary angiography revealed significant calcification of the ascending aorta (porcelain aorta) and coronary arteries. Coronary artery lesions: 90% unstable LM stenosis, significant calcified stenosis of the circumflex artery (CA), middle left anterior descending artery (mid-LAD), and chronic coronary occlusion of the right coronary artery, besides, 5 episodes of ventricular tachycardia were recorded. Despite the high SYNTAX Score I and SYNTAX Score II, due to the clinical picture and heart rhythm disorders, the heart team decided to perform emergency PCI. Bare-metal stent for LM – mid-LAD was implanted and angioplasty of mid-LAD was performed. Rough calcification of LM caused stent recoil; postdilatation of LM stent by high pressure balloon (p = 25 atm) was performed. The operation ended with a good angiographic result. The woman was discharged in a stable condition to plan further intervention in 1 month.&#x0D; Stage 2. A 81-year-old woman with complaints of severe chest pain was re-hospitalized with NSTEMI to the National Amosov Institute of Cardiovascular Surgery 3 months after the primary PCI. Echocardiography revealed EF 53%; valvular pathology and segmental contraction defects were not detected. Urgent coronary angiography revealed 90% of LM stenosis (stent recoil – loss of radial rigidity). Gradual angioplasty of LM stenosis and CA stenosis were performed.&#x0D; Stage 3. For reinforcing the radial rigidity in LM, LM – CA drug-eluting stent was implanted. Angioplasty of LM and CA using kissing balloon technique was performed. Final proximal optimization of LM showed good angiographic result.

Long-Term Outcomes of Unprotected Left Main Percutaneous Coronary Intervention in Centers Without Onsite Cardiac Surgery

Unprotected left main (LM) percutaneous coronary intervention (PCI) at centers without onsite cardiac surgery remains controversial. We aimed to evaluate the effect of onsite cardiac surgery on short-term and long-term outcomes in patients who had unprotected LM PCI. We analyzed Victorian Cardiac Outcomes Registry data on consecutive patients who had unprotected LM PCI at cardiac surgical centers (SCs) and non-SCs (NSCs) between January 2014 to December 2018. Compared with the SC group (n=594, 81%), the NSC group (n=136) were younger (69 vs 72years) and presented with more ST-elevation myocardial infarction (35% vs 16%) and cardiogenic shock (25% vs 15%), with higher rates of preprocedural intubation (17% vs 11%) and mechanical circulatory support (20% vs 9.3%), all p<0.01. Unadjusted in-hospital mortality (23% vs 11.4%), and 30-day major adverse cardiac events (composite of mortality, myocardial infarction, stent thrombosis, or unplanned revascularization) (26% vs 16%) were higher in NSC patients, all p<0.01. However, following multivariable adjustment, SC was neither a predictor of in-hospital mortality (odds ratio 0.68, 95% confidence interval [CI] 0.32 to 1.43, p=0.31), 30-day mortality (odds ratio 0.70, 95% CI 0.33 to 1.48, p=0.35) nor long-term survival at 60months (hazard ratio 0.88, 95% CI 0.62 to 1.27, p=0.51). Propensity score analysis confirmed the neutral effect of onsite cardiac surgery on long-term survival (hazard ratio 0.99, 95% CI 0.66 to 1.50, p=0.97). In conclusion, patients who underwent unprotected LM PCI at NSCs presented with greater acuity of illness. Despite this, the availability of onsite cardiac surgical support was not associated with in-hospital, 30-day, or long-term outcomes underscoring the safety of LM PCI in NSCs.

Validation of the V-RESOLVE (Visual Estimation for Risk prEdiction of Side Branch OccLusion in Coronary Bifurcation interVEntion) score system in unprotected left main bifurcation.

This study aimed to assess the risk of side branch (SB) occlusion using the V-RESOLVE (The Visual Estimation for Risk prEdiction of Side Branch OccLusion in Coronary Bifurcation interVEntion) score in unprotected left main (LM) bifurcation percutaneous coronary intervention (PCI). The V-RESOLVE score is a validated score system, based on visual estimation of angiographic data, for prediction of the risk of SB occlusion after main vessel (MV) stenting in non-LM bifurcation lesions. However, its predictive value for unprotected LM bifurcation lesions remains to be validated. From January 2014 to December 2016, 855 patients undergoing unprotected LM bifurcation PCI using a provisional strategy were included. Baseline and prestenting angiographic data were analyzed, and the V-RESOLVE score was calculated. SB occlusion was defined as any decrease in thrombolysis in myocardial infarction (TIMI) flow grade or the absence of flow in the SB after MV stenting. The predictive performance of the V-RESOLVE score was judged by discrimination, calibration, and clinical application. vSB occlusion occurred in 19 (2.2%) of 855 unprotected LM bifurcation PCI procedures using a provisional strategy. The V-RESOLVE score for SB occlusion had brilliant discrimination (the area under the receiver operating characteristic curve = 0.80, 95% confidence interval [CI]: 0.77-0.84) and good calibration (Hosmer-Lemeshow: p = 0.154). Stratified by the V-RESOLVE score, significantly higher rates of SB occlusion were observed in the high-risk group (score: 12-43) compared with the nonhigh-risk group (score: 0-11) (4.4% vs. 0.6%, p < 0.001). The V-RESOLVE score is a promising tool to predict the risk of SB occlusion and facilitate decision-making for unprotected LM bifurcation PCI.

First experience with orbital atherectomy in calcified unprotected left main percutaneous coronary intervention.

First experience with orbital atherectomy in calcified unprotected left main percutaneous coronary intervention.

TCT-100 Real-World Experience and Outcomes of Protected Versus Unprotected Left Main Percutaneous Coronary Intervention: Insights From the VA CART Program

TCT-100 Real-World Experience and Outcomes of Protected Versus Unprotected Left Main Percutaneous Coronary Intervention: Insights From the VA CART Program

One-year Outcome of Different Unprotected Left Main Percutaneous Coronary Interventions Techniques in Acute Coronary Syndromes

Background: We intended in this study to evaluate the impact of the different techniques of unprotected left main coronary artery (ULMCA) stenting on the clinical outcomes.&#x0D; Methods: The study included 65 patients with ACS and left main disease subjected to UPLMCA intervention [46 males (70.8%) with median(Q1-Q3) age of 63(53-70) years old] in an observational prospective cohort study. Data were collected through reviewing patient’s medical records and angiographic procedures. Angiographic assessment included evaluation of Syntax II score, EURO II score, and TIMI flow grading. The primary outcome was the major adverse cardiac and cerebral events (MACCE) at 1 year while the secondary outcomes included the development of acute kidney injury (AKI), one year mortality, and need for CABG post PCI.&#x0D; Results: One-year MACCE was 46.2 % when the angle between LAD and LCX was&gt;70o compared to 81.5% when it was less than 70o (P=0.008). The wide angle was also associated with 0% 1-year mortality compared to 18.5% for narrow angle, a difference which is statistically significant (P=0.03). The 1-year MACCE was 35.7% compared to 74.4% when it was not used (P=0.013). When POT was used, the 1-year MACCE was 47.6% compared to 75% when it was not used (P=0.041). None of the other studied parameters including those related to procedure technique was significantly affecting the outcome in our study.&#x0D; Conclusion: We concluded that the non-use of FKI nor POT together with the lower angulation between LAD and LCX could predict worse clinical outcome at one-year in unprotected left main PCI.

Unprotected Left Main Percutaneous Coronary Intervention With or Without Hemodynamic Support

Hemodynamic support is widely utilized for unprotected left main (ULM) percutaneous coronary interventions (PCI) despite lack of evidence from randomized studies and the risk of device-related complications. We aimed to compare ULMPCI with and without intra-aortic balloon pump (IABP) support. A single-center, retrospective analysis was performed for patients undergoing ULMPCI with and without IABP support. Clinical, procedural, in-hospital, and 30-day cardiovascular outcomes were compared. From 2003 through 2018, 217 patients underwent non-emergent ULMPCI, 55 with elective IABP support (IABP group), and 162 without support (No-IABP group). The study population comprised 56.4% men and 74.5% Caucasians in the IABP group and 53.7% men and 62.3% Caucasians in the No-IABP group. The mean age for IABP and No-IABP group patients was 75.75 ± 12.34 years and 73.47 ± 15.19 years, respectively (p=0.315). Procedural success was achieved in 99% of IABP and 95.3% of No-IABP patients (p=0.089). In-hospital and 30-day mortality was 5.5% for the IABP group and 5.6% for the No-IABP group (p=0.977). Rates of major complications were statistically similar between the groups. Bailout IABP was required in 10% of No-IABP patients. Hospital and intensive care unit length of stay was statistically longer in the IABP group. In conclusion, ULMPCI without IABP support was not associated with increased mortality and major cardiovascular outcomes compared with supported patients and was associated with shorter hospital and intensive care unit stay. A randomized trial comparing unsupported versus supported ULMPCI is warranted to identify patients who would benefit from hemodynamic support.