scholarly journals TCT-285 Ten year follow-up results of left main percutaneous coronary intervention in elderly patients

2016 ◽  
Vol 68 (18) ◽  
pp. B117
Author(s):  
Ignacio Sanchez-Perez ◽  
Jesus Piqueras-Flores ◽  
Fernando Lozano ◽  
María Thiscal López Lluva ◽  
Natalia Pinilla-Echeverri ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Elderly Patients ◽  
Coronary Intervention ◽  
Left Main ◽  
Percutaneous Coronary

scholarly journals TCT-812 Ten years follow-up results of left main percutaneous coronary intervention in elderly patients

2017 ◽  
Vol 70 (18) ◽  
pp. B330
Author(s):  
Ignacio Sanchez-Perez ◽  
Jesus Piqueras-Flores ◽  
Fernando Lozano ◽  
María Thiscal López Lluva ◽  
Natalia Pinilla-Echeverri ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Elderly Patients ◽  
Coronary Intervention ◽  
Left Main ◽  
Percutaneous Coronary

Abstract 1849: Comparison of Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention for the Treatment of Unprotected Left Main Coronary Disease in Octogenarians

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jonathan DeBlois ◽  
Pierre Voisine ◽  
Olivier F Bertrand ◽  
Siamak Mohammadi ◽  
Gerald Barbeau ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Cerebrovascular Event ◽  
Left Main ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Background: Very little data exists regarding percutaneous coronary intervention (PCI) as an alternative to coronary artery bypass graft (CABG) for the treatment of unprotected left main disease (LMD) in octogenarians, and no studies to date have compared CABG and PCI for the treatment of LMD in this population. The objectives of our study were to compare the acute and midterm follow-up results of PCI and CABG for the treatment of significant LMD in octogenarians. Methods: A total of 163 consecutive patients ≥80 years old diagnosed with LMD have undergone coronary revascularization in our center between 2002 and 2006. One hundred and one patients underwent CABG and 62 patients had PCI (non-surgical candidates: 30%, very high surgical risk patients: 61%, patient refusal of CABG: 9%). All complications occurring within the first 30 days following the procedure were recorded, and major adverse cardiovascular events -MACCE- (cardiac death, myocardial infarction, cerebrovascular event, revascularization) were evaluated at follow-up. Results: Patients who underwent PCI were older (85 ± 3 yrs vs. 82 ± 2 yrs, p<0.0001), presented more frequently with an acute coronary syndrome (92% vs. 50%, p<0.0001), and had a higher EuroSCORE (9.5 ± 2.7 vs. 8.5 ± 2.5, p=0.01). Drug-eluting stents were used in 48% of PCI patients. There were no significant differences in the incidence of MACCE at 30 days between groups (CABG: 28%, PCI: 19%, p=0.22), but the CABG group was associated with a higher rate of atrial fibrillation (48% vs. 14%, p<0.0001) and acute renal failure (17% vs. 6%, p=0.05). The incidence of MACCE occurring between 30 days and 24 ± 17 months follow-up was higher in the PCI group (32% vs. 13%, p=0.005), but the cumulative incidence of MACCE was similar in both groups (CABG 39% vs. PCI 44%, p=0.53). Conclusions: PCI was associated with a 30-day cardiac event rate similar to that of CABG for the treatment of unprotected LMD in octogenarians. Surgical patients experienced fewer cardiac events during the follow-up period, but the cardiovascular event-free survival rate was similar between groups at 2-year follow-up. Further randomized studies with longer-term follow-up comparing both revascularization strategies in this high risk coronary population are warranted.

scholarly journals Identify Unsuitable Patients with Left Main Coronary Artery Disease in Intermediate SYNTAX Scores Treated by Percutaneous Coronary Intervention

2017 ◽  
Vol 20 (6) ◽  
pp. 258 ◽  
Author(s):  
Chunxiao Zhang ◽  
Yaguang Zheng ◽  
Xinbin Liu ◽  
Yutong Cheng ◽  
Yang Liu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Repeated Revascularization

Background: With the follow-up extending to 5 years, the outcomes of SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) trial were comparable between coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in left-main (LM) patients with intermediate SYNTAX scores of 23–32. A subdivision depending on SYNTAX score will help to identify unsuitable LM patients with intermediate SYNTAX scores to receive PCI treatment.Methods: Between January 2011 and June 2013, 104 patients with LM Coronary Artery Disease (CAD) undergoing PCI were selected retrospectively. We compared clinical outcomes in patients with SYNTAX score <27 and ≥27. The follow-up time was 25.23 ± 7.92 months. Kaplan-Meier survival analyses and Cox proportional hazards models were used to compare various outcomes between two groups.Results: Higher rates of repeated revascularization (18.2% versus 4.2%, P = .027) and major adverse cerebro-cardiovascular events (MACCE) (24.2% versus 7.0%, P = .014) were shown in patients with SYNTAX score ≥ 27. After multivariate adjustment, a significant higher risk of repeated revascularization (hazard ratio: 6.25, 95% confidence interval: 1.48 to 26.37, P = .013) and MACCE (hazard ratio: 4.49, 95% confidence interval: 1.41 to 14.35, P = .011) were also found in patients with SYNTAX score ≥ 27.Conclusions: Based on the higher rate of repeated revascularization and MACCE, patients with LM CAD and intermediate SYNTAX scores will need a subdivision to identity the one not benefit from PCI. CABG is still the standard treatment method for patients of LM CAD with a SYNTAX score of ≥ 27.

P6263Results of percutaneous coronary intervention of unprotected left main coronary disease in octogenarian patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M J Romero Reyes ◽  
A Moya Martin ◽  
N Gonzalez Alemany ◽  
F J Sanchez Burguillos ◽  
P Perez Santigosa ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Mortality Rate ◽  
Coronary Disease ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Long Term Results ◽  
Left Main ◽  
Percutaneous Coronary

Abstract Introduction Conservative treatment unprotected left main coronary (uLMCA) disease has a high mortality rate (50% at 3 years). Since octogenarian patients are often dismissed for surgical treatment, they tend to adopt a more conservative attitude in this population. Purpose We report medium and long-term outcomes of percutaneous coronary intervention (PCI) for uLCMA stenosis in elderly patients. Methods Retrospective cohort study of consecutive patients ≥80 years with uLMCA stenosis, treated with PCI at a single center between June 2005 and February 2017. Results A total of 100 patients were included in the study. 58% were male, with a mean age of 83.8±3 years. There were 86% hypertensive, 63% diabetic and 68% dyslipidemic. 14% of the patients had an LVEF ≤35%. Unstable angina (45%) and acute coronary syndromes withouth ST-segment elevation (44%) were the most common presentation. In 9% of the cases, cardiogenic shock was the initial presentation form. The distal left main coronary was the most frequent localitation of the lesion (46%) followed by the ostium (33%). In 63% of the cases, a multivessel coronary disease was detected and in 47% the revascularization was incomplete. The survival rate after a year follow up was 79% and after three years follow up was 65%. However, in most of the cases the cause of death was due to other comorbidities, with cardiac death being 10% per year and 13% at 3 years of follow-up. The rate of non-fatal acute myocardial infarction was 13% per year, increasing to 20% at 3 years of follow-up. There was a 9% stent restenosis implanted at 3 years. The presence of severe left ventricular systolic dysfunction was the main predictor of mortality in long-term follow-up (OR 1.39 [95% CI 1.10–1.752], p<0.001). Incomplete revascularization was not associated with a higher mortality rate. Conclusion PCI is a safety option for revascularization in uLMCA stenosis in elderly patientes with excellent short-term results, as well as acceptable long-term results. Age should not be a handicap to consider uLMCA revascularization in this population.

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