Backgtound: PCI has emerged as a possible alternative to CABG in carefully selected patients with left main coronary disease (LMCD). Lesion complexity of the coronary tree is quantified using the SYNTAX score. Patients with LMCD and SYNTAX score (SS) ≥33 had a higher mortality rate with PCI than with CABG. Nonetheless, the ESC revascularization guidelines allows PCI in LMCD and a SYNTAX score
Methods: From a prospective cohort of all patients who underwent PCI at our center we selected patients who underwent unprotected LM PCI. In order to define the impact of the SS on intermediate-term prognosis, we excluded patients who died during the first month following the procedure. The primary outcome was 12 months mortality.
Results: 203 patients underwent unprotected LM PCI. The mean age was 73±12, 67% were males and 33% women, 64% had LVEF<40%, 31% had renal failure, 37% had DM, 76% had hypertension, 16% had prior stroke and 17% had PVD. 120 patients (59%) presented with ACS and 12% sustained STEMI event. 25 patients arrived in shock and their one-month mortality was 52%. Of the 171 patients who survived the 1st month, the one-year mortality was 14.6%. Using a univariate analysis, shock at presentation, LVEF<40%, RF, anemia, number of vessel involved and use of BMS stents were associated with poor long-term survival. On multivariate analysis only renal failure and number of vessels were associated with poor long-term survival. A detailed analysis of the survival according to the SS is currently undergoing analysis and will be presented at the IHA conference.
Conclusion: One-year survival of high-risk patients undergoing unprotected LM PCI is 14.6% and poor survival is associated with renal failure and multi-vessel disease. The impact of the SS on mortality will be defined and presented at the meeting.
