Predictors of 30-day and 12-month mortality in left main stem percutaneous coronary intervention 2016-2020: A study from two UK centers.
| Title: | Predictors of 30-day and 12-month mortality in left main stem percutaneous coronary intervention 2016-2020: A study from two UK centers. |
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| Authors: | Carande EJ; Department of Cardiology, Morriston Cardiac Centre, Swansea, UK.; Protty MB; Systems Immunity University Research Institute, Cardiff University, Cardiff, UK.; Verhemel S; Department of Cardiology, The Grange University Hospital, Cwmbran, UK.; Hussein MH; Department of Cardiology, Morriston Cardiac Centre, Swansea, UK.; Raman AS; Department of Cardiology, Morriston Cardiac Centre, Swansea, UK.; UlHaq Z; Department of Cardiology, Morriston Cardiac Centre, Swansea, UK.; Bundhoo S; Department of Cardiology, The Grange University Hospital, Cwmbran, UK.; Cullen J; Department of Cardiology, The Grange University Hospital, Cwmbran, UK.; Ionescu A; Department of Cardiology, Morriston Cardiac Centre, Swansea, UK.; Choudhury A; Department of Cardiology, Morriston Cardiac Centre, Swansea, UK.; Hussain HI; Department of Cardiology, The Grange University Hospital, Cwmbran, UK.; Hailan A; Department of Cardiology, Morriston Cardiac Centre, Swansea, UK. |
| Source: | Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2022 Oct; Vol. 100 (4), pp. 585-592. Date of Electronic Publication: 2022 Sep 14. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Wiley-Liss Country of Publication: United States NLM ID: 100884139 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1522-726X (Electronic) Linking ISSN: 15221946 NLM ISO Abbreviation: Catheter Cardiovasc Interv Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: New York, NY : Wiley-Liss, c1999- |
| MeSH Terms: | Coronary Artery Disease*/diagnostic imaging ; Coronary Artery Disease*/therapy ; Percutaneous Coronary Intervention*/adverse effects ; Acute Coronary Syndrome*; United Kingdom/epidemiology ; Humans ; Risk Factors ; Shock, Cardiogenic ; Treatment Outcome |
| Abstract: | Introduction: Left main stem percutaneous coronary intervention (LMS-PCI) is a complex high-risk procedure which can be performed as an alternative to coronary artery bypass graft (CABG) procedure in surgical turn-down patients or where there is equipoise in percutaneous versus surgical strategies. Current guidelines suggest that PCI is an appropriate alternative to CABG in patients with unprotected LMS disease and low SYNTAX score. However, "real world" data on outcomes of LMS-PCI remain limited. This study aims to quantify and determine predictors of mortality following LMS-PCI.; Methods: Using local coronary angioplasty registries from two UK centers, all LMS-PCI cases were identified from 2016 to 2020. Descriptive statistics and multivariate logistic regressions were used to examine the association between baseline and procedural characteristics with 30-day and 12-month mortality.; Results: We identified 484 cases of LMS-PCI between 2016 and 2020. There was a year-on-year increase in the number of LMS-PCI, the highest being in 2020. Covariates associated with higher 30-day mortality were age (OR 1.07, 95% CI: 1.02-1.12) and shock preprocedure (OR 23.88, 95% CI: 7.90-72.20). Covariates associated with higher 12-month mortality were age (OR 1.04, 95% CI: 1.01-1.08), acute coronary syndrome (ACS) (OR 2.50, 95% CI: 1.08-5.80), renal disease (OR 5.24, 95% CI: 1.47-18.68), and shock preprocedure (OR 7.93, 95% CI: 3.30-19.05). Overall, 30-day and 12-month mortality in this contemporary data set were 9.5% and 16.7%, respectively, with significantly lower rates in elective cases (p |
| References: | Ragosta M, Dee S, Sarembock IJ, Lipson LC, Gimple LW, Powers ER. Prevalence of unfavorable angiographic characteristics for percutaneous intervention in patients with unprotected left main coronary artery disease. Catheter Cardiovasc Interv. 2006;68:357-362.; Buszman PE, Buszman PP, Kiesz RS, et al. Early and long-term results of unprotected left main coronary artery stenting: the LE MANS (left main coronary artery stenting) registry. J Am Coll Cardiol. 2009;54:1500-1511.; Stone GW, Sabik JF, Serruys PW, et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med. 2016;375:2223-2235. doi:10.1056/NEJMoa1610227.; Fisher L. Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery. Survival data. Circulation. 1983;68:939-950.; Varnauskas E. Twelve-year follow-up of survival in the randomized European Coronary Surgery Study. N Engl J Med. 1988;319:332-337.; Silber S, Albertsson P, Avilés FF, et al. Guidelines for percutaneous coronary interventions. The task force for percutaneous coronary interventions of the European Society of Cardiology. Eur Heart J. 2005;26:804-847.; Serruys PW, Morice M-C, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961-972.; Mäkikallio T, Holm NR, Lindsay M, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet. 2016;388:2743-2752.; Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2019;40:87-165.; Ludman PF. British Cardiovascular Intervention Society Registry for audit and quality assessment of percutaneous coronary interventions in the United Kingdom. Heart. 2011;97:1293-1297.; Wang T, Kerr A, Kasargod C, et al. Percutaneous coronary intervention for left main coronary disease in New Zealand: national linkage study of characteristics and in-hospital outcomes (ANZACS-QI 38). Cardiovasc Revascularization Med. 2020;21:573-579.; Kinnaird T, Johnson T, Anderson R, et al. Intravascular imaging and 12-month mortality after unprotected left main stem PCI: an analysis from the British Cardiovascular Intervention Society Database. JACC Cardiovasc Interv. 2020;13:346-357.; Kurki TS, Kataja M, Reich DL. Emergency and elective coronary artery bypass grafting: comparisons of risk profiles, postoperative outcomes, and resource requirements. J Cardiothorac Vasc Anesth. 2003;17:594-597.; Yap J, Singh GD, Kim JS, et al. Outcomes of primary percutaneous coronary intervention in acute myocardial infarction due to unprotected left main thrombosis: the Asia-pacific left main ST-elevation registry (ASTER). J Interv Cardiol. 2018;31:129-135.; Almudarra SS, Gale CP, Baxter PD, et al. 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). JACC Cardiovasc Interv. 2014;7:717-730.; Van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2017;136:e232-e268.; Lee CH, Chong SZ, Hsueh SK, Chung WJ, Cheng CI. Residual right coronary artery stenosis after left main coronary artery intervention increased the 30-day cardiovascular death and 3-year right coronary artery revascularization rate. J Interv Cardiol. 2020;2020:4587414.; Nagaraja V, Ooi SY, Nolan J, et al. Impact of incomplete percutaneous revascularization in patients with multivessel coronary artery disease: a systematic review and meta-analysis. J Am Heart Assoc. 2016;5:1-22.; Gershlick AH, Khan JN, Kelly DJ, et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for stemi and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol. 2015;65:963-972.; Di Gioia G, Sonck J, Ferenc M, et al. Clinical outcomes following coronary bifurcation PCI techniques: a systematic review and network meta-analysis comprising 5,711 patients. JACC Cardiovasc Interv. 2020;13:1432-1444.; Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur J Cardio-thoracic Surg. 2018;53:34-78. |
| Contributed Indexing: | Keywords: complex coronary angioplasty; complications; coronary artery disease; epidemiology; left main stem; mortality; outcomes; percutaneous coronary intervention |
| Entry Date(s): | Date Created: 20220915 Date Completed: 20221012 Latest Revision: 20221013 |
| Update Code: | 20260130 |
| DOI: | 10.1002/ccd.30400 |
| PMID: | 36104863 |
| Database: | MEDLINE |
Journal Article