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Comparative outcomes after unprotected left main stem percutaneous coronary intervention: a national linked cohort study of 5,065 acute and elective cases from the BCIS Registry (British Cardiovascular Intervention Society).
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2014 Jul; Vol. 7 (7), pp. 717-30. - Publication Year :
- 2014
-
Abstract
- Objectives: The goal of this study was to report outcomes from percutaneous coronary intervention (PCI) to an unprotected left main stem (UPLMS) stenosis according to presenting syndrome, including ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation acute coronary syndrome (NSTEACS), and chronic stable angina (CSA).<br />Background: There are no published whole-country data concerning patient outcomes following PCI to UPLMS.<br />Methods: This study is a prospective national cohort study using data from the British Cardiovascular Intervention Society (BCIS) registry from January 1, 2005, through December 31, 2010.<br />Results: Of 5,065 patients having PCI to an UPLMS, 784 (15.5%) presented with STEMI, 2,381 (47.0%) with NSTEACS, and 1,900 (37.5%) with CSA. Crude 30-day and 1-year mortality rates were STEMI: 28.3% and 37.6%, NSTEACS: 8.9% and 19.5%, and CSA: 1.4% and 7.0%, respectively. Unadjusted in-hospital major adverse cardiovascular and cerebrovascular event rates were STEMI: 26.6%, NSTEACS: 6.6%, and CSA: 3.3%. Risk of 30-day mortality was much greater for STEMI and NSTEACS patients than CSA (STEMI adjusted odds ratio [aOR]: 29.45, 95% confidence interval [CI]: 19.37 to 44.80, NSTEACS aOR: 6.45, 95% CI: 4.27 to 9.76). More than 40% of patients presenting with STEMI had cardiogenic shock, in whom mortality was higher than in STEMI cases without shock (30 days: 52.0% vs. 11.7%, 1 year: 61.1% vs. 20.9%). Radial access, compared with the femoral approach, was associated with a lower risk of 30-day mortality (STEMI aOR: 0.37, 95% CI: 0.21 to 0.62; NSTEACS aOR: 0.66, 95% CI: 0.45 to 0.97).<br />Conclusions: More than one-half of the patients who received UPLMS PCI were acute where outcomes were much worse than elective cases. Cardiogenic shock is common in STEMI patients, of whom more than one-half die at 30 days. The radial approach was associated with reduced early mortality in acute cases.<br /> (Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Acute Coronary Syndrome diagnosis
Acute Coronary Syndrome mortality
Aged
Aged, 80 and over
Angina, Stable diagnosis
Angina, Stable mortality
Cerebrovascular Disorders etiology
Cerebrovascular Disorders mortality
Chi-Square Distribution
Comparative Effectiveness Research
Female
Femoral Artery
Humans
Kaplan-Meier Estimate
Linear Models
Male
Middle Aged
Myocardial Infarction diagnosis
Myocardial Infarction mortality
Odds Ratio
Proportional Hazards Models
Prospective Studies
Radial Artery
Registries
Risk Factors
Shock, Cardiogenic etiology
Shock, Cardiogenic mortality
Time Factors
Treatment Outcome
United Kingdom
Acute Coronary Syndrome therapy
Angina, Stable therapy
Myocardial Infarction therapy
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention methods
Percutaneous Coronary Intervention mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 7
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 25060013
- Full Text :
- https://doi.org/10.1016/j.jcin.2014.03.005