Long-term (≥15 years) Follow-up of Percutaneous Coronary Intervention of Unprotected Left Main (From the GRAVITY Registry)

https://doi.org/10.1016/j.amjcard.2021.06.008Get rights and content

Long term survival and its determinants after Percutaneous Coronary Intervention (PCI) on Unprotected Left Main Coronary Artery (ULMCA) remain to be appraised. In 9 European Centers 470 consecutive patients performing PCI on ULMCA between 2002 and 2005 were retrospectively enrolled. Survival from all cause and cardiovascular (CV) death were the primary end points, while their predictors at multivariate analysis the secondary ones. Among the overall cohort 81.5% of patients were male and mean age was 66 ± 12 years. After 15 years (IQR 13 to 16), 223 patients (47%) died, 81 (17.2%) due to CV etiology. At multivariable analysis, older age (HR 1.06, 95%CI 1.02 to 1.11), LVEF < 35% (HR 2.97, 95%CI 1.24 to 7.15) and number of vessels treated during the index PCI (HR 1.75, 95%CI 1.12 to 2.72) were related to all-cause mortality, while only LVEF <35% (HR 4.71, 95%CI 1.90 to 11.66) to CV death. Repeated PCI on ULMCA occurred in 91 (28%) patients during the course of follow up and did not significantly impact on freedom from all-cause or CV mortality. In conclusion, in a large, unselected population treated with PCI on ULMCA, 47% died after 15 years, 17% due to CV causes. Age, number of vessels treated during index PCI and depressed LVEF increased risk of all cause death, while re-PCI on ULMCA did not impact survival.

Section snippets

Methods

GRAVITY is a multicenter retrospective registry including consecutive patients undergoing unprotected left main PCI between June 2002 and 2005 at 9 European centers). The study complies with the Declaration of Helsinki: all patients provided informed consent for inclusion in the registry, and institutional review board approval was obtained at each center.

Cardiovascular risk factors, clinical presentation, angiographic features, use of intravascular imaging, bifurcation technique details,

Results

General characteristics of overall cohort are reported in Table 1. The mean age at the enrollment was 66.6 years (SD 11.7), 71.5% of patients were male and hypertension was the most common cardiovascular risk factor (81.9%), while 34.1% of patients were active smokers. Admission diagnosis was STEMI in 14.4% of the cases, while mean creatinine at admission was 1.2 mg/dl (SD 0.8). At the time of discharge mean LVEF was 48% (SD 16.8) and dual antiplatelet therapy (DAPT) was prescribed in 88.1% of

Discussion

The main findings of this multicenter retrospective cohort study assessing the long-term outcome of PCI on ULMCA are:

  • 1)

    Less than 20% of patients with PCI on ULMCA died for CV reasons at 15 years

  • 2)

    A severe systolic dysfunction at discharge (LVEF < 35%) was the only independent predictor of long-term CV mortality, with no other clinical, angiographic or procedural factors affecting CV outcome.

  • 3)

    Most of re-PCI on ULMCA occurred during the first year and were predicted by clinical presentation and

Disclosure

Nothing to declare.

Declaration of Competing Interests

The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this study.

Acknowledgment

Nothing to declare.

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