Current Use and Trends in Unprotected Left Main Coronary Artery Percutaneous Intervention

Nagarajarao, Harsha S.; Ojha, Chandra; Mulukutla, Venkatachalam; Ibrahim, Ahmed; Mares, Adriana; Paul, Timir K.

doi:10.1007/s11886-020-1268-8

Cited by 10 publications

(4 citation statements)

References 73 publications

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“…The Syntax Score (SS) is an established tool for assessing the complexity of coronary artery disease (CAD), particularly in patients with multivessel coronary artery disease and/or left main coronary artery lesions [ 29 , 30 ]. The SS is primarily based on the location, type, and number of coronary artery lesions, providing robust theoretical support for the choice between PCI and Coronary Artery Bypass Grafting (CABG) [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

A nomogram model for predicting intramyocardial hemorrhage post-PCI based on SYNTAX score and clinical features

Yang,

Xi,

Duan

et al. 2024

BMC Cardiovasc Disord

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Objective The aim of this study is to develop a nomogram model for predicting the occurrence of intramyocardial hemorrhage (IMH) in patients with Acute Myocardial Infarction (AMI) following Percutaneous Coronary Intervention (PCI). The model is constructed utilizing clinical data and the SYNTAX Score (SS), and its predictive value is thoroughly evaluated. Methods A retrospective study was conducted, including 216 patients with AMI who underwent Cardiac Magnetic Resonance (CMR) within a week post-PCI. Clinical data were collected for all patients, and their SS were calculated based on coronary angiography results. Based on the presence or absence of IMH as indicated by CMR, patients were categorized into two groups: the IMH group (109 patients) and the non-IMH group (107 patients). The patients were randomly divided in a 7:3 ratio into a training set (151 patients) and a validation set (65 patients). A nomogram model was constructed using univariate and multivariate logistic regression analyses. The predictive capability of the model was assessed using Receiver Operating Characteristic (ROC) curve analysis, comparing the predictive value based on the area under the ROC curve (AUC). Results In the training set, IMH post-PCI was observed in 78 AMI patients on CMR, while 73 did not show IMH. Variables with a significance level of P < 0.05 were screened using univariate logistic regression analysis. Twelve indicators were selected for multivariate logistic regression analysis: heart rate, diastolic blood pressure, ST segment elevation on electrocardiogram, culprit vessel, symptom onset to reperfusion time, C-reactive protein, aspartate aminotransferase, lactate dehydrogenase, creatine kinase, creatine kinase-MB, high-sensitivity troponin T (HS-TnT), and SYNTAX Score. Based on multivariate logistic regression results, two independent predictive factors were identified: HS-TnT (Odds Ratio [OR] = 1.61, 95% Confidence Interval [CI]: 1.21–2.25, P = 0.003) and SS (OR = 2.54, 95% CI: 1.42–4.90, P = 0.003). Consequently, a nomogram model was constructed based on these findings. The AUC of the nomogram model in the training set was 0.893 (95% CI: 0.840–0.946), and in the validation set, it was 0.910 (95% CI: 0.823–0.970). Good consistency and accuracy of the model were demonstrated by calibration and decision curve analysis. Conclusion The nomogram model, constructed utilizing HS-TnT and SS, demonstrates accurate predictive capability for the risk of IMH post-PCI in patients with AMI. This model offers significant guidance and theoretical support for the clinical diagnosis and treatment of these patients.

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Section: Discussionmentioning

confidence: 99%

A nomogram model for predicting intramyocardial hemorrhage post-PCI based on SYNTAX score and clinical features

Yang,

Xi,

Duan

et al. 2024

BMC Cardiovasc Disord

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“…LM lesions used to be considered off-limits to PCI, but with the increasing development of interventional techniques, PCI has become the main treatment for LM lesions [21,22] .The EXCEL study included 1,905 patients with LM lesions, randomized to PCI and CABG, showed an increased incidence of the 5-year composite endpoint in current smokers compared with nonsmokers, with no increased risk seen in exsmokers [23] . The SYNTAX study was also performed in patients with more complex coronary artery disease and dynamically observed the smoking status of patients during the follow-up period, and similar conclusions were yield with further analysis [24] .…”

Section: Discussionmentioning

confidence: 99%

The Impact of Smoking Status on the Long-Term Prognosis of Male Patients Underwent Percutaneous Coronary Intervention of Left Main Coronary Artery

Qiao¹,

Hao-bo²,

Guo³

et al. 2020

Preprint

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Objective: To evaluate the impact of smoking status on the long-term prognosis of male patients with left main coronary artery lesions who received percutaneous coronary intervention. Methods: A retrospective analysis was conducted. A total of 3122 male patients with left main lesions who received percutaneous coronary intervention in our hospital were categorized by smoking status at admission: 1207 in the non-smokers group, 1339 in the current smokers group, and 576 in the ex-smokers group. The patients were followed up for 3 years. The main study endpoints were major cardiovascular adverse events (composite endpoints of all-cause death, all myocardial infarctions and revascularization) and target lesion failure (composite endpoints of cardiogenic death, target vessel-related myocardial infarction, target vessel-related blood flow reconstruction). Results: The patients in the current smokers group was younger than the non-smokers group and the ex-smokers group (p<0.0001). In terms of prognosis, no statistical significance observed in the incidence of composite end point of MACE (p=0.9866), target lesion failure (p=0.2522), and stent thrombosis (p=0.2118), all-cause death (p=0.3130), cardiogenic death (p=0.2509), revascularization (p=0.5028), target vessel-related revascularization (p=0.9866), and stroke (p=0.3895), among the three groups. The current smokers group had the lowest incidence of myocardial infarction while ex-smokers group had the highest incidence rate(5.67%vs.5.10%vs.2.97%,p=0.0072), and so is the incidence of myocardial infarction related to target vessels (5.48%vs.5.10%vs.2.89%,p=0.0067). According to Cox regression analysis, history of myocardial infarction(HR=1.339，95%CI：1.042-1.722，p=0.0227), and baseline SYNTAX score(HR=1.0333, 95%CI:1.017-1.049,p<0.0001) are independent risk factors of MACE, while current smoking(HR=0.793,95%CI：0.646-0.974,p=0.0274) proves to be an independent protective factor of target vessel related myocardial infarction. Conclusion: For male patients with the left main coronary artery lesions receiving PCI, smoking has no impact on the long-term MACE or target lesion failure, current smoking is an independent protective factor for target vessel related myocardial infarction.

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“…As clinical and angiographic characteristics of patients undergoing PCI with DES have evolved substantially over the last 20 years, current trends indicate that approximately 30% of all PCI procedures may be considered complex according to lesion or anatomic factors (3). Owing to technical and methodological advancements, patients who were previously treated medically or surgically, are now often offered PCI with an emphasis on unprotected left main disease (ULMD) (4)(5)(6) and CTO (7). In order to successfully predict and identify patients who are prone to increased residual ischemic risk, these intricate procedures require interventional cardiologists to use both clinical (8) and angiographic (9) risk scores, and implement treatment accordingly.…”

Section: Introductionmentioning

confidence: 99%

Temporal Trends in Complex Percutaneous Coronary Interventions

Kheifets

Vons

Bental

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAccumulated experience combined with technological advancements in percutaneous coronary interventions (PCI) over the past four decades, has led to a gradual increase in PCI utilization and complexity. We aimed to investigate the temporal trends in PCI complexity and the outcomes of complex PCI (C-PCI) in our institution.MethodsWe analyzed 20,301 consecutive PCI procedures performed over a 12-year period. C-PCI was defined as a procedure involving at least one of the following: Chronic total occlusion (CTO), left main (LM), bifurcation or saphenous vein graft (SVG) PCI. Four periods of 3-year time intervals were defined (2008–10, 2011–2013, 2014–2016, 2017–2019), and temporal trends in the rate and outcomes of C-PCI within these intervals were studied. Endpoints included mortality and major adverse cardiac events [MACE: death, acute myocardial infarction (MI), and target vessel revascularization (TVR)] at 1 year.ResultsA total of 5,647 (27.8%) C-PCI procedures were performed. The rate of C-PCI has risen significantly since 2,017 (31.2%, p < 0.01), driven mainly by bifurcation and LM interventions (p < 0.01). At 1-year, rates of death, acute MI, TVR and MACE, were all significantly higher in the C-PCI group (8.8 vs. 5.1%, 5.6 vs. 4.5%, 5.5 vs. 4.0%, 17.2 vs. 12.2%, p < 0.001 for all, respectively), as compared to the non-complex group. C-PCI preformed in the latter half of the study period (2014–2019) were associated with improved 1-year TVR (4.4% and 4.8% vs. 6.7% and 7.1%, p = 0.01, respectively) and MACE (13.8% and 13.5% vs. 17.3% and 18.2%, p = 0.001, respectively) rates compared to the earlier period (2007–2013). Death rate had not significantly declined with time.ConclusionIn the current cohort, we have detected a temporal increase in PCI complexity coupled with improved 1-year clinical outcomes in C-PCI.

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Current Use and Trends in Unprotected Left Main Coronary Artery Percutaneous Intervention

Cited by 10 publications

References 73 publications

A nomogram model for predicting intramyocardial hemorrhage post-PCI based on SYNTAX score and clinical features

A nomogram model for predicting intramyocardial hemorrhage post-PCI based on SYNTAX score and clinical features

The Impact of Smoking Status on the Long-Term Prognosis of Male Patients Underwent Percutaneous Coronary Intervention of Left Main Coronary Artery

Temporal Trends in Complex Percutaneous Coronary Interventions

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