Unprotected left main percutaneous coronary intervention: prognostic value of SYNTAX score II

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Published Oct 4, 2019
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Vol. 97 No. 4 (2019): Issue Apr 2019

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Selim Boudiche
Omar Guermazi
Fares Azaiez
Manel Ben Halima
Bassem Rekik
Nadim Khader
Hatem Aloui
Abdeljelil Farhati
Noureddine Larbi
Fathia Mghaieth
Sana Ouali
Mohamed Sami Mourali

Abstract

Background
Unprotected left main (LM) coronary artery disease (CAD) represents a challenging lesion with a major prognostic impact.
Aim: Evaluate the clinical outcome and major adverse cardiac events (MACE) predictors of unprotected LM percutaneous coronary intervention (PCI) in an "all-comers" population.
Methods: We performed a prospective observational study of patients with unprotected LM stenosis treated by PCI. MACE were defined as the composite endpoint of all-cause death, myocardial infarction and target lesion revascularization.
Results: From January 2012 to December 2017, 150 consecutive patients who underwent unprotected LM PCI were included. The mean age was 64±12 years and 75.3% were males. Diabetes was noted in 50.7%. Emergent revascularization was performed in 20.7% of cases, including 3.3% patients with cardiogenic shock. Distal LM was involved in 76.7% of cases. A majority of patients (94.0%) had low or intermediate SYNTAX Score I (≤32). The median SYNTAX score II was 31.1. Drug-eluting stents were used in 78.7% and bare metal stents in 21.3% of patients, mainly in emergent setting where the former were unavailable. In distal LM PCI, provisional approach was mostly used (81.7%). The median follow-up was 13.4 months. MACE occurred in 23.3% with an estimate of 37.9% at 5 years. Significant predictors of MACE were cardiogenic shock, bare metal stents use, previous PCI, and SYNTAX score II ≥30.
Conclusion: Unprotected LM PCI presents encouraging short and long term outcomes. SYNTAX score II might represent a predictor for long-term outcome in this particular lesion subset.

Keywords:

: Unprotected left main, percutaneous coronary intervention, outcome, SYNTAX score II

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