Pre-procedure cardiogenic shock and older age tied to mortality in left main stem-PCI: Study
UK: Pre-procedure cardiogenic shock and older age are associated with an increased risk of 30-day mortality following left main stem percutaneous coronary intervention (LMS-PCI), according to a recent study in Catheterization and Cardiovascular Interventions.
Left main stem percutaneous coronary intervention, a complex high-risk procedure, can be performed as an alternative to coronary artery bypass graft (CABG) procedure in patients with surgical turn-down or where there is equipoise in surgical versus percutaneous strategies. Current guidelines have indicate that PCI is a suitable alternative to CABG in patients with low SYNTAX score and unprotected LMS disease. However, there is limited "real world" data on outcomes of LMS-PCI.
Against the above background, Elliott J. Carande, Department of Cardiology, Morriston Cardiac Centre, Swansea, UK, and colleagues aimed to determine and quantify mortality predictors after LMS-PCI.
The researchers identified all LMS-PCI cases from 2016 to 2020 using local coronary angioplasty registries from two UK centers. The association between baseline and procedural characteristics were examined with 30-day and 12-month mortality using multivariate logistic regressions and descriptive statistics. A total of 484 cases of LMS-PCI were identified between 2016 and 2020.
The study led to the following findings:
- There was a year-on-year increase in the number of LMS-PCI, the highest being in 2020.
- Covariates associated with higher 30-day mortality were age (OR 1.07) and shock preprocedure (OR 23.88).
- Covariates associated with higher 12-month mortality were age (OR 1.04), renal disease (OR 5.24), acute coronary syndrome (ACS) (OR 2.50), and shock preprocedure (OR 7.93).
- 30-day and 12-month mortality in this contemporary data set were 9.5% and 16.7%, respectively, with significantly lower rates in elective cases.
"Cardiogenic shock and older age preprocedure were linked with increased 30-day mortality after LMS-PCI," the researchers wrote. "Twelve-month mortality was tied to ACS presentation, older age, cardiogenic shock preprocedure, and preexisting renal disease."
Reference:
Carande EJ, Protty MB, Verhemel S, Hussein MH, Raman AS, UlHaq Z, Bundhoo S, Cullen J, Ionescu A, Choudhury A, Hussain HI, Hailan A. Predictors of 30-day and 12-month mortality in left main stem percutaneous coronary intervention 2016-2020: A study from two UK centers. Catheter Cardiovasc Interv. 2022 Sep 14. doi: 10.1002/ccd.30400. Epub ahead of print. PMID: 36104863.
