Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2019
Short-term clinical outcomes of percutaneous coronary intervention of unprotected left main coronary disease in cardiogenic shock.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Castro-Mejía Alex F, Ortega-Armas María E, Mejía-Rentería Hernán, Gonzalo Nieves, Salinas Pablo, Nombela-Franco Luis, Del Trigo María, Jiménez-Quevedo Pilar, Escaned Javier, Fernández-Ortiz Antonio, Macaya Carlos, Nuñez-Gil Iván J
Аннотация
BACKGROUND: Percutaneous coronary intervention (PCI) of left main (LM) disease in patients with cardiogenic shock (CS) represents a clinical challenge. Evidence on clinical outcomes according to revascularization strategies in this scenario remains scarce. The objective was to investigate the short-term outcomes according to treatment strategies for this population.
METHODS: We retrospectively analyzed 78 consecutive patients who underwent PCI of LM in established CS at two experienced centers. Characteristics of PCI and short-term clinical outcomes were assessed.
RESULTS: LM stenosis was considered the culprit lesion in 49 patients (62.8%). In the remaining cases, LM stenosis was treated after successful PCI of the culprit vessel because of persistent CS. The majority of patients presented complex coronary anatomy (43.6% had Syntax score > 32). Complete revascularization was performed in 34.6%; a 2-stents technique in the LM bifurcation was used in 12.8% and intra-aortic balloon pump (IABP) in 73.1%. In-hospital mortality was 48.7%. At 90 days follow-up it was 50% without differences between 1 or 2 stent LM bifurcation-techniques (p = .319). Mortality was higher in patients with partial revascularization and residual Syntax score ≥ 15 (p < .05 by univariate analysis), and in those with TIMI flow<3 in the left coronary artery at the end of PCI (p < .05 by multivariate analysis). There were no significant differences in the use of IABP in relation to 90-day mortality (p = .92).
CONCLUSIONS: In patients presenting with cardiogenic shock and LM disease, neither 2-stents strategy in the LM nor use of IABP displayed a reduced short-term mortality. However, patients with final TIMI flow <3 presented higher short-term mortality in our series.
METHODS: We retrospectively analyzed 78 consecutive patients who underwent PCI of LM in established CS at two experienced centers. Characteristics of PCI and short-term clinical outcomes were assessed.
RESULTS: LM stenosis was considered the culprit lesion in 49 patients (62.8%). In the remaining cases, LM stenosis was treated after successful PCI of the culprit vessel because of persistent CS. The majority of patients presented complex coronary anatomy (43.6% had Syntax score > 32). Complete revascularization was performed in 34.6%; a 2-stents technique in the LM bifurcation was used in 12.8% and intra-aortic balloon pump (IABP) in 73.1%. In-hospital mortality was 48.7%. At 90 days follow-up it was 50% without differences between 1 or 2 stent LM bifurcation-techniques (p = .319). Mortality was higher in patients with partial revascularization and residual Syntax score ≥ 15 (p < .05 by univariate analysis), and in those with TIMI flow<3 in the left coronary artery at the end of PCI (p < .05 by multivariate analysis). There were no significant differences in the use of IABP in relation to 90-day mortality (p = .92).
CONCLUSIONS: In patients presenting with cardiogenic shock and LM disease, neither 2-stents strategy in the LM nor use of IABP displayed a reduced short-term mortality. However, patients with final TIMI flow <3 presented higher short-term mortality in our series.