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Short‐term clinical outcomes of percutaneous coronary intervention of unprotected left main coronary disease in cardiogenic shock
Author(s) -
CastroMejía Alex F.,
OrtegaArmas María E.,
MejíaRentería Hernán,
Gonzalo Nieves,
Salinas Pablo,
NombelaFranco Luis,
Trigo María,
JiménezQuevedo Pilar,
Escaned Javier,
FernándezOrtiz Antonio,
Macaya Carlos,
NuñezGil Iván J.
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28404
Subject(s) - medicine , conventional pci , cardiogenic shock , cardiology , percutaneous coronary intervention , timi , revascularization , coronary artery disease , stenosis , myocardial infarction , angioplasty , culprit , univariate analysis , surgery , multivariate analysis
Background Percutaneous coronary intervention (PCI) of left main (LM) disease in patients with cardiogenic shock (CS) represents a clinical challenge. Evidence on clinical outcomes according to revascularization strategies in this scenario remains scarce. The objective was to investigate the short‐term outcomes according to treatment strategies for this population. Methods We retrospectively analyzed 78 consecutive patients who underwent PCI of LM in established CS at two experienced centers. Characteristics of PCI and short‐term clinical outcomes were assessed. Results LM stenosis was considered the culprit lesion in 49 patients (62.8%). In the remaining cases, LM stenosis was treated after successful PCI of the culprit vessel because of persistent CS. The majority of patients presented complex coronary anatomy (43.6% had Syntax score > 32). Complete revascularization was performed in 34.6%; a 2‐stents technique in the LM bifurcation was used in 12.8% and intra‐aortic balloon pump (IABP) in 73.1%. In‐hospital mortality was 48.7%. At 90 days follow‐up it was 50% without differences between 1 or 2 stent LM bifurcation‐techniques ( p = .319). Mortality was higher in patients with partial revascularization and residual Syntax score ≥ 15 ( p < .05 by univariate analysis), and in those with TIMI flow<3 in the left coronary artery at the end of PCI ( p < .05 by multivariate analysis). There were no significant differences in the use of IABP in relation to 90‐day mortality ( p = .92). Conclusions In patients presenting with cardiogenic shock and LM disease, neither 2‐stents strategy in the LM nor use of IABP displayed a reduced short‐term mortality. However, patients with final TIMI flow <3 presented higher short‐term mortality in our series.