One-year outcome of different unprotected left main percutaneous coronary interventions techniques in acute coronary syndromes

Abstract

BACKGROUND: Percutaneous coronary intervention (PCI) to unprotected left main coronary artery (ULMCA) showed recently great evolution with better outcomes. The long-term outcome of the different techniques needs to be evaluated. AIM: We intended in this study to evaluate the impact of the different techniques of ULMCA stenting on the clinical outcomes. METHODS: We included 65 patients with acute coronary syndrome and left main (LM) disease subjected to ULMCA intervention during the period from September 2018 to January 2020 in our multicenter observational prospective study. We excluded patients with age <18 and >75 years old, patients with conditions that interfere with LM coronary intervention, patients who refused to be included in study, and those with previous coronary artery bypass graft (CABG). Data were collected through reviewing patient’s medical records and angiographic procedures. Angiographic assessment included evaluation of Syntax II score, EURO II score, and TIMI flow grading. The primary outcome was the major adverse cardiac and cerebral events (MACCE) at 1 year while the secondary outcomes included the development of acute kidney injury, 1 year mortality, and need for CABG post-PCI. RESULTS: We included 46 males (70.8%) with median (Q1–Q3) age of 63 (53–70) years old. One-year MACCE was 46.2% when the angle between left anterior descending (LAD) and left circumflex (LCX) was >70° compared to 81.5% when it was <70° (p = 0.008). The wide angle was also associated with 0% 1-year mortality compared to 18.5% for narrow angle, a difference which is statistically significant (p = 0.03). The 1-year MACCE was 35.7% compared to 74.4% when it was not used (p = 0.013). When proximal optimization technique (POT) was used, the 1-year MACCE was 47.6% compared to 75% when it was not used (p = 0.041). None of the other studied parameters including those related to procedure technique was significantly affecting the outcome in our study. CONCLUSIONS: We concluded that the non-use of final kissing inflation nor POT together with the lower angulation between LAD and LCX could predict worse clinical outcome at 1-year in unprotected LM PCI.