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Predictors of survival in patients with acute coronary syndrome undergoing percutaneous coronary intervention of unprotected left main coronary artery stenosis

Predictors of survival in patients with acute coronary syndrome undergoing percutaneous coronary intervention of unprotected left main coronary artery stenosis

Authors :
Wolfgang Bothe
Constantin von zur Muehlen
Peter Stachon
Manfred Zehender
Viviane Zotzmann
Christoph Bode
Andreas Zirlik
Dawid L. Staudacher
Charlotte Schmitt
Source :
Catheterization and Cardiovascular Interventions. 96
Publication Year :
2019
Publisher :
Wiley, 2019.

Abstract

OBJECTIVE Aim of this study was to investigate predictors of survival in unstable patients with high SYNTAX-1-score. BACKGROUND In significant unprotected left main coronary artery (ULMCA) stenosis, treatment options include percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). While CABG is recommended for stable patients with ULMCA stenosis and a SYNTAX-1-score > 32, PCI may be preferable in unstable or high operative risk patients. METHODS Retrospective single-center all-comers registry study. RESULTS A total of 142 patients underwent ULMCA-PCI (~72.9 years, 23.2% females, 54.2% survival in 2-year follow-up), 84 of whom had a SYNTAX-1 > 32 (37.4 ± 12.8). Patients in the high-SYNTAX-1-group (score > 32) were more often in an acute condition compared to low-SYNTAX-2-group (score ≤ 32) including acute myocardial infarction (76.2% vs. 57.4%, p = .024), cardiogenic shock (48.2% vs. 14.8%, p = .001), or need for mechanical support (36.1% vs. 11.1%, p = .001). Survival was predicted by the acute condition including cardiogenic shock (OR 0.06 and 0.05) and myocardial infarction (OR 0.03 and 0.34) in both groups. Performance of the SYNTAX-1-score was limited in our patient collective in both groups (c-index 0.65 vs. 0.63) while SYNTAX-2-PCI-score performed better (c-index 0.67 vs. 0.67). EuroScore II had the best discriminative ability (c-index 0.87 vs. 0.78). CONCLUSIONS The majority of patients undergoing ULMCA-PCI presented in acute conditions with high SYNTAX-1-score, and is therefore underrepresented in clinical trials. Prognosis was best predicted by the acute condition and the EuroScore II. These data suggest that therapy in unstable patients should be guided by clinical condition over the anatomical SYNTAX-1-score.

Details

ISSN :
1522726X and 15221946
Volume :
96
Database :
OpenAIRE
Journal :
Catheterization and Cardiovascular Interventions
Accession number :
edsair.doi.dedup.....0d3832de0b3bbbe3ad7734009f814266
Full Text :
https://doi.org/10.1002/ccd.28495