Author + information
- Bashir Alaour,
- Eunice Onwordi,
- Asif Khan and
- Ali Dana
LMS coronary disease is associated with high morbidity and mortality. CABG has traditionally been the standard treatment. PCI is increasingly regarded as a viable alternative with comparable outcome and safety profile in select groups. We evaluated the outcomes of unprotected LMS PCI in a large UK non-surgical centre.
Data on all LMS PCI procedures between 2011-2016, excluding patients with previous CABG surgery, was collected from the local BCIS database and electronic patient records. Periprocedural and 1-year MACE [all-cause mortality, MI, stroke and target vessel revascularization (TVR)] were recorded.
Two hundred forty-nine patients had LMS intervention during the study period. All non-emergency cases were discussed by the heart team. Seventy-seven percent (n=192) were male. Mean age 70 ± 12 years. Thirty-one percent of cases were elective, 44% NSTEMI, 25% STEMI. Seventy-seven percent of procedures were performed trans-radially. Anatomical distribution: 19% ostial, 31% shaft and 50% bifurcation. Additional intra-coronary imaging was used in 55%. Ninety-two percent of patients had DES. Twenty-two percent of patients had severe LV impairment pre-procedure and 13 % were in cardiogenic shock on presentation. 4.8% had acute LMS occlusion and 0.4 % had chronic occlusion. Rotablation was used in 16%. Thirty-five patients (14%) required IABP support. PCI techniques included: Culotte 19%, 2-stent crush in 2%, T-stenting in 11% and single stent in 68%. Seventy-three percent had PCI on additional lesions at the same setting. Periprocedural complications included: coronary perforation in 1.2 %, side branch occlusion in 3.2%, heart block requiring pacing in 0.8%, and cardiogenic shock induced by procedure in 2.4%. 98.4% of procedures were successful. No patients required emergency transfer for CABG. There were 25 (10%) in-hospital deaths. Sixty-eight percent of in-hospital deaths occurred in patients undergoing primary PCI for STEMI. Seventy-two percent of patients who died were in cardiogenic shock at presentation. Twelve-month MACE was 19.6%. Death occurred in 14%, MI in 2.4%, TVR in 2.4% and stroke in 0.8% (ischemic etiology).
These results highlight the safety and efficacy of unprotected LMS PCI in a non-surgical centre.