Abstract 12075: Mortality Rate after Left Main Stem Percutaneous Coronary Intervention for Different Clinical Syndromes.
Introduction: In the UK, CABG has been the standard of care for treating left main stem (LMS) disease. As the number of emergency cardiac catheterisations has risen, an increasing proportion of acute coronary syndrome (ACS) patients have PCI for LMS lesions.
Hypothesis: Mortality following LMS PCI depends on clinical presentation.
Methods: We conducted a retrospective observational study of long term mortality on 303 consecutive patients who had LMS PCI at our regional cardiothoracic centre from 9th Aug 2002 to 19th Apr 2010. Data were analysed with SPSS. Groups were compared using a Chi-squared test for categorical data and an independent t test for continuous variables. A Cox regression model using complete cases (n=243) was fitted to investigate the effect of patient characteristics on 3 clinical groups: stable angina/elective; NSTEMI/semi-acute; STEMI/emergency. We considered the following covariates: EF<30%; history of CRF; age; length of stented segment.
Results: Mean (95% CI) time to death=1607.5 days (1535.8–1679.1). There was a significant difference in total all cause mortality by clinical presentation; angina: 2.0%, NSTEMI: 13.8%, STEMI 25.9%, P <0.001. Death rate was greatest early, and highest in the STEMI group. EF<30%, renal failure and length of stented segment were not predictive of mortality.
Conclusion: There is a significant difference in long term mortality rate after LMS PCI based on clinical presentation. Patients having LMS PCI for chronic stable angina have an excellent prognosis. ACS patients do worse, the highest risk period being peri-procedure. Primary PCI to the LMS for STEMI is a very high risk clinical scenario, but patients surviving to 30 days do well.
- © 2010 by American Heart Association, Inc.