Short-term clinical outcomes of percutaneous coronary intervention of unprotected left main coronary disease in cardiogenic shock.
Aged
Aged, 80 and over
Coronary Angiography
Coronary Stenosis
/ diagnostic imaging
Female
Hospital Mortality
Humans
Intra-Aortic Balloon Pumping
/ adverse effects
Male
Middle Aged
Percutaneous Coronary Intervention
/ adverse effects
Retrospective Studies
Risk Factors
Shock, Cardiogenic
/ diagnosis
Spain
Stents
Time Factors
Treatment Outcome
acute coronary syndrome
cardiogenic shock
left main disease
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
15 02 2020
15 02 2020
Historique:
received:
27
03
2019
revised:
14
06
2019
accepted:
02
07
2019
pubmed:
28
7
2019
medline:
29
9
2020
entrez:
28
7
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
515-521Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
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