Background: Percutaneous coronary intervention (PCI) is considered an efficacious and safe approach to Unprotected Left Main Disease (ULMD) in randomized evidence in patients with low and intermediate Syntax Score (SX); however long-term clinical outcomes of PCI in real world patients remains still to be assessed, as prognostic role of Syntax score and other clinical and instrumental scores like ACEF, Euroscore and Clinical Syntax. Methods: All consecutive patients, selected from July 2002 to December 2006, undergoing PTCA in our Center for critical LM stenosis (>50%), were included. Patients were divided into 3 tertiles based on the values of Syntax: low risk (SXlow risk: ≤22),Mid risk (SXmid risk: >22 and <33) and high risk (SXhigh risk: ≥33). Major Adverse Cardiac and Cerebrovascular Events (MACCE) at 5-years follow-up were the primary end point, while their single components represented secondary end points. Independent predictive power of ACEF, modified ACEF, Syntax and Clinical Syntax scores and their area under the curve were appraised. Results: 72 patients with SXlow risk, 76 patients with SXmid risk and 43 patients with SX high risk were included. MACCE incidence was significantly higher in the SXhigh risk compared with the others (74.41% vs 51.32% vs 43.66%; p=0.01), mainly driven by re-PTCA. Moreover, we can see that the most important component of revascularization was, specifically, non TV re-PTCA (non target vessels revascularization), expression of progression of coronary disease (14.71% vs 24.00% vs 35.71% respectively in the three groups; p=0.039, specifically 0.011 between the first and the third group). MACCE occurred earlier in SXhigh risk compared with the other two tertiles (1.62±1.49 years vs 0.97±0.88 years vs 0.87±0.74 years; p<0.0001). About risk scores we evidenced that Syntax score was a good predictor for revascularization but not for death, while ACEF or Modified ACEF score for death (AUC for both 0.8: 0.7-0.9, CI 95%) resulted both significant and accurate. Conclusions: PCI on left main real world patients may be considered as a safe and effective alternative to CABG, specially in patients with low and mid risk. Accuracy of angiographic scores appears unsatisfactory, while ACEF or Modified ACEF performed best.
Long term outcomes in patients who underwent percutaneous coronary intervention on left main coronary artery according to clinical and angiographic scores
D'ASCENZO, FABRIZIO;DI CUIA, Marco;GAITA, Fiorenzo
2013-01-01
Abstract
Background: Percutaneous coronary intervention (PCI) is considered an efficacious and safe approach to Unprotected Left Main Disease (ULMD) in randomized evidence in patients with low and intermediate Syntax Score (SX); however long-term clinical outcomes of PCI in real world patients remains still to be assessed, as prognostic role of Syntax score and other clinical and instrumental scores like ACEF, Euroscore and Clinical Syntax. Methods: All consecutive patients, selected from July 2002 to December 2006, undergoing PTCA in our Center for critical LM stenosis (>50%), were included. Patients were divided into 3 tertiles based on the values of Syntax: low risk (SXlow risk: ≤22),Mid risk (SXmid risk: >22 and <33) and high risk (SXhigh risk: ≥33). Major Adverse Cardiac and Cerebrovascular Events (MACCE) at 5-years follow-up were the primary end point, while their single components represented secondary end points. Independent predictive power of ACEF, modified ACEF, Syntax and Clinical Syntax scores and their area under the curve were appraised. Results: 72 patients with SXlow risk, 76 patients with SXmid risk and 43 patients with SX high risk were included. MACCE incidence was significantly higher in the SXhigh risk compared with the others (74.41% vs 51.32% vs 43.66%; p=0.01), mainly driven by re-PTCA. Moreover, we can see that the most important component of revascularization was, specifically, non TV re-PTCA (non target vessels revascularization), expression of progression of coronary disease (14.71% vs 24.00% vs 35.71% respectively in the three groups; p=0.039, specifically 0.011 between the first and the third group). MACCE occurred earlier in SXhigh risk compared with the other two tertiles (1.62±1.49 years vs 0.97±0.88 years vs 0.87±0.74 years; p<0.0001). About risk scores we evidenced that Syntax score was a good predictor for revascularization but not for death, while ACEF or Modified ACEF score for death (AUC for both 0.8: 0.7-0.9, CI 95%) resulted both significant and accurate. Conclusions: PCI on left main real world patients may be considered as a safe and effective alternative to CABG, specially in patients with low and mid risk. Accuracy of angiographic scores appears unsatisfactory, while ACEF or Modified ACEF performed best.
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