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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
- 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.
- Subjects :
- Male
medicine.medical_specialty
Acute coronary syndrome
Time Factors
medicine.medical_treatment
Left Main Coronary Artery Stenosis
030204 cardiovascular system & hematology
Coronary Angiography
Risk Assessment
Decision Support Techniques
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Health Status Indicators
Humans
Radiology, Nuclear Medicine and imaging
Registries
030212 general & internal medicine
Myocardial infarction
Acute Coronary Syndrome
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Cardiogenic shock
Coronary Stenosis
Percutaneous coronary intervention
General Medicine
Middle Aged
medicine.disease
humanities
Stenosis
Treatment Outcome
medicine.anatomical_structure
Conventional PCI
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Artery
Subjects
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