Unprotected left-main coronary percutaneous intervention in elderly: a retrospective analysis of practice and clinical outcome

AIMS In this study, conducted in a high-volume catheterization centre without on-site cardiothoracic surgical support, we aim to assess the efficacy and feasibility of percutaneous coronary intervention (PCI) of unprotected left main disease (LMD) in at least of 75 years old patients, compared with younger ones. METHODS The study population consisted of 145 patients, allocated into two groups: those with age < or ≥ of 75 years old. The median period of follow-up was 48 months. The primary end-point was the incidence of major adverse cardiovascular events (MACE) defined as the composite of death from cardiac causes, non-fatal myocardial infarction (MI) and clinically driven target vessel revascularization. RESULTS Smoking habit and family history of coronary artery disease (CAD) were more frequent in patients with age less than of 75 years. The older group had more frequently hypertension and renal failure, and a higher median value of logistic EuroSCORE. Three-vessel disease and calcifications were more frequent in patients with age at least of 75 years old. Median time of MACEs was 6 months. There were no differences regarding MACEs and other single end-points between the two groups. In patients with age less than 75 years, clinical presentation of stable CAD was the only predictor of MACEs. In the older group, clinical presentation of no ST-segment elevation MI represented the only predictor of MACEs. CONCLUSIONS In the elderly patients, PCI of LMD seems technically feasible and a good alternative to surgery in a high-volume catheterization centre without on-site cardiothoracic surgical support.