Abstract 3655: Left Main Stenting in Octogenarians, Comparison with Predicted Surgical Outcome. Results from the Taxus Pilot Study
Background: Left main (LM) stenting using DES has emerged as an alternative to surgery in some centers. However, it’s unknown whether the mortality of this strategy is different from that of cardiac surgery in high risk patienst such as octogenarians.
Objectives and Methods: We sought evaluate the results of DES with a Paclitaxel eluting stent for the treatment of left main lesions in patients > 80 years and compared the outcome to the in-hospital mortality rate predicted by means of Euroscore if the same patients had CABG surgery.
Results: A total of 53 patients (18.3% of the patients in the Left Main Taxus Pilot Study) were > 80 years. Patients were 84±3 years old, 59% male, 69% with hypertension, 15% diabetes, 54% dyslipidemia, 24% smoker or pervious smoker and 11% had a family history of coronary disease. They had unstable angina in 42% of cases and recent MI in 23%. Coronary angiogramm showed 3-vessel disease in 45% of cases and distal LM lesion disease in 85%. Ejection fraction was 55±15%. The mean Eursocore was 8.5±3.9 and predicted in-hospital mortality 16.3±20.2%. The procedure was successfull in all cases. The in-hospital mortality was 2% (severe access site complication). At 8–12 months follow-up total mortality rate was 4% (1 additional patient died from pulmonary infection at 2 months), target vessel revascularization rate was 8% and MACC E rate 13%.
Conclusion: Observed in-hospital mortality after LM stenting in octogenerians is markedly lower than predicted surgical mortality by means of Euroscore. After a median follow-up of 8 months the mortality rate remains relatively low in this high risk population with comorbidities.