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Predictors of survival in patients with acute coronary syndrome undergoing percutaneous coronary intervention of unprotected left main coronary artery stenosis
Author(s) -
Staudacher Dawid L.,
Schmitt Charlotte,
Zirlik Andreas,
Zehender Manfred,
Stachon Peter,
Bothe Wolfgang,
Zotzmann Viviane,
Bode Christoph,
Muehlen Constantin
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.28495
Subject(s) - medicine , percutaneous coronary intervention , conventional pci , cardiology , cardiogenic shock , myocardial infarction , acute coronary syndrome , euroscore , stenosis , artery
Abstract Objective Aim of this study was to investigate predictors of survival in unstable patients with high SYNTAX‐1‐score. Background In significant unprotected left main coronary artery (ULMCA) stenosis, treatment options include percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). While CABG is recommended for stable patients with ULMCA stenosis and a SYNTAX‐1‐score > 32, PCI may be preferable in unstable or high operative risk patients. Methods Retrospective single‐center all‐comers registry study. Results A total of 142 patients underwent ULMCA‐PCI (~72.9 years, 23.2% females, 54.2% survival in 2‐year follow‐up), 84 of whom had a SYNTAX‐1 > 32 (37.4 ± 12.8). Patients in the high‐SYNTAX‐1‐group (score > 32) were more often in an acute condition compared to low‐SYNTAX‐2‐group (score ≤ 32) including acute myocardial infarction (76.2% vs. 57.4%, p = .024), cardiogenic shock (48.2% vs. 14.8%, p = .001), or need for mechanical support (36.1% vs. 11.1%, p = .001). Survival was predicted by the acute condition including cardiogenic shock (OR 0.06 and 0.05) and myocardial infarction (OR 0.03 and 0.34) in both groups. Performance of the SYNTAX‐1‐score was limited in our patient collective in both groups (c‐index 0.65 vs. 0.63) while SYNTAX‐2‐PCI‐score performed better (c‐index 0.67 vs. 0.67). EuroScore II had the best discriminative ability (c‐index 0.87 vs. 0.78). Conclusions The majority of patients undergoing ULMCA‐PCI presented in acute conditions with high SYNTAX‐1‐score, and is therefore underrepresented in clinical trials. Prognosis was best predicted by the acute condition and the EuroScore II. These data suggest that therapy in unstable patients should be guided by clinical condition over the anatomical SYNTAX‐1‐score.