Asia PCR Presentation – Result of 7 years follow up post Left Main Stenting

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LEFT MAIN STENTING

  • Stenting of narrowed or blocked coronary arteries is a common and relatively easy procedure
  • However, stenting of the Left Main requires more experience and expertise as mishaps may result in unacceptable complication or death
  • I have been doing Left Main stenting since 2007
  • We have been collecting these cases and follow up with their progress
  • In more recent years, my colleagues in Changi General Hospital also contributed cases into our follow up series
  • In January of 2016, we have the privilege of presenting our results in the Asia PCR/SingLive conference
  • This is one of largest series and longest follow up coming out of Singapore with a maximum follow up of 7 years
  • I am pleased to say that our results are comparable to those of international standard
  • The following slides were presented by Dr. Mathew Liew at the meeting with minor edits

Outcome of unprotected left main coronary artery percutaneous coronary intervention: Single centre longitudinal follow up study

Background

  • There has been increasing data regarding PCI of the unprotected left main coronary artery (ULMCA) and their outcomes. However there is a lack of data on the longer term outcomes in our local population following such intervention.
  • Aim: To evaluate the long term outcomes of patients who underwent unprotected left main PCI in our local population

Method

  • A retrospective analysis of all ULMCA PCI cases that were performed from 2007 to 2013
    • on an urgent basis
    • had refused surgical revascularization
  • Baseline demographics and follow up outcomes were collected
  • Mean follow up period was 3 years (range = 3 to 7 years)
  • Multivariate analysis was performed using the statistic program SPSS version 19 to identify potential predictors of adverse outcomes

Elective vs unplanned LM PCI

  • In the elective PCI group:
    • More frequent femoral use (93.3% vs 56.5%)
    • No IABP inserted
    • Fewer patients with EF <40% (20.5% vs 56.5%)
    • Fewer patients with Medina (1,1,1) anatomy (11.1% vs 30.4%)
    • Fewer patients with Euroscore >5 (40% vs 82.6%)

Results

  • Overall MACE rates: 11.8% (8 out of 68 cases)
    • Death: 10.3%
    • Target lesion revascularisation: 1.5%
  • Elective PCI: 6.6%
    • 2 deaths (4.4%) out of 45 patients
    • Of which one was sepsis, and one was sudden death
    • 1 target lesion revascularisation (2.2%)

Results

Non-elective PCI: 42.5%

  • 5 deaths
    • Acute LM occlusion cases (5 out of 11, 42.5%)
    • Presented with cardiogenic shock

Results

  • Use of IABP (P = 0.05) (patients in cardiogenic shock) and low ejection fraction (<40%) (p = 0.04) were independent predictors of MACE at 3years.
  • High Syntax score, use of DES, 1 vs 2 stent technique did not predict MACE at 3 years.

Discussion

  • There is small number of subjects
    • However, this has a long follow up period
  • Lower rate of re-look angiogram
    • This implies that there was low clinical events
  • Overall MACE in elective arm was low
  • There was only 1 case of ISR requiring revascularization

CONCLUSION

  • The incidence of adverse events associated with unprotected left main coronary artery stenting is low
    • Mitigated by better stent technology, better antithrombotic options, imaging adjuncts
  • Predictors of adverse events in our centre are the use of IABP (cardiogenic shock) and presence of low ejection fraction
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