Left main PCI in patients without right coronary artery support showed no significant difference in long-term all-cause mortality compared to those with RCA support (23% vs 20%; P=0.37).
Cohort (n=385)
No
Does unprotected left main PCI in the absence of right coronary artery support increase long-term all-cause mortality or periprocedural complications compared to those with RCA support in patients with ULMCAD?
Unprotected left main PCI can be performed safely even in the absence of right coronary artery support, with similar periprocedural complications and long-term mortality compared to patients with RCA support.
Absolute Event Rate: 23% vs 20%
p-value: p=0.37
BACKGROUND: Many operators are discouraged from performing left main (LM) percutaneous coronary interventions (PCI) in the absence of right coronary artery (RCA) support due to the increased procedure risk. AIMS: We aimed at assessing the impact of absent functional RCA on prognostic implications in patients undergoing unprotected LM PCI. METHODS: 613 patients underwent LM PCI in our department between 2015 and 2019. Consecutive 385 patients with unprotected LM and at least 1-year follow-up were included in the study. The study population comprosed 272 patients with unprotected left main coronary artery disease (ULMCAD) with dominant RCA, without any significant lesions (Group 1), and 113 ULMCAD patients and without RCA support (Group 2). RESULTS: In Group 2, 32.7% patients had a significant RCA stenosis, 48.7% had chronic total occlusion (CTO) of RCA, and 18.6% had recessive RCA. Patients in Group 2 were older and had higher prevalence of chronic obstructive pulmonary disease (COPD). SYNTAX Score (median IQR 26.0 20.0-33.0 vs 19.0 13.0-25.5; P <0.001) was higher and left ventricular ejection fraction was lower (median IQR 50.0 40.0-60.0% vs 55.0 45.0-60.0%; P = 0.01) in this group. All periprocedural complications did not differ among the groups. Long-term all-cause mortality at a median follow-up of 1149 days did not differ significantly (23% vs 20%; P = 0.37). The long-term mortality in CTO-RCA group was also not significantly different. CONCLUSIONS: Patients with ULMCAD who have undergone LM PCI in the absence of RCA support, compared with those with ULMCAD and RCA support, differed neither in the prevalence of periprocedural complications nor in long-term all-cause mortality.
Skorupski et al. (Mon,) conducted a cohort in Unprotected left main coronary artery disease (n=385). Left main PCI without right coronary artery support vs. Left main PCI with right coronary artery support was evaluated on Long-term all-cause mortality (p=0.37). Left main PCI in patients without right coronary artery support showed no significant difference in long-term all-cause mortality compared to those with RCA support (23% vs 20%; P=0.37).
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