Abstract
Background
Patients presenting with non-ST–elevation acute coronary syndrome (NSTE-ACS) and unprotected
left main coronary disease (ULMCD) are among the highest risk patients but current
consensus guidelines do not address the optimal timing and mode of revascularization
for these individuals.
Methods
In this single-centre registry, we evaluated the clinical outcomes of 151 consecutive
patients with NSTE-ACS and ULMCD who underwent percutaneous coronary intervention
with drug-eluting stents from 2005 to 2009.
Results
Overall in-hospital major adverse cardiac event (MACE) rate was 5.3%, mortality rate
was 0.7%. At 30 months ± 15 months, 30 patients (19.9%) experienced MACE. The 4-year
cumulative survival rate of no MACE was 73.2% and cumulative survival rate was 90.6%.
Left ventricular ejection fraction (hazard ratio [HR] 0.947; 95% confidence interval
[CI], 0.898-0.998; P = 0.043) and SYNTAX [SYNergy between percutaneous coronary intervention with TAXus
and cardiac surgery] score ≥ 33 (HR 1.28; 95% CI, 1.025-1.433; P = 0.029) were associated with MACE, while only left ventricular ejection fraction
(HR 0.82; 95% CI, 0.69-0.973; P = 0.023) was associated with mortality.
Conclusions
Our study demonstrates the feasibility of percutaneous coronary intervention with
drug-eluting stents in patients with NSTE-ACS and ULMCD. The early and long-term outcomes
were acceptable. Left ventricular ejection fraction and SYNTAX score ≥ 33 predict
MACE and only left ventricular ejection fraction predicts mortality.
Résumé
Introduction
Les patients qui présentent un syndrome coronarien aigu (SCA) sans sus-décalage du
segment ST et une maladie du tronc coronarien gauche non protégé (maladie du TCGNP)
sont parmi les patients à risque le plus élevé, mais les lignes directrices consensuelles
actuelles ne tiennent pas compte du moment optimal et du mode de revascularisation
pour ces individus.
Méthodes
Dans ce registre unicentrique, nous avons évalué les résultats cliniques de 151 patients
consécutifs avec un SCA sans sus-décalage du segment ST et une maladie du TCGNP qui
ont subi une intervention coronarienne percutanée réalisée avec une endoprothèse à
élution de médicaments de 2005 à 2009.
Résultats
Le taux de l'ensemble des événements cardiaques indésirables majeurs (ÉCIM) intrahospitaliers
a été de 5,3 % et le taux de mortalité a été de 0,7 %. À 30 mois ± 15 mois, 30 patients
(19,9 %) ont expérimenté des ÉCIM. Le taux de survie cumulatif après 4 ans sans ÉCIM
a été de 73,2 % et le taux de survie cumulatif a été de 90,6 %. La fraction d'éjection
ventriculaire gauche (rapport de risque [RR] 0,947; intervalle de confiance [IC] de
95 %, 0,898-0,998; P = 0,043) et le score SYNTAX ≥ 33 (RR 1,28; IC de 95 %, 1,025-1,433; P = 0,029) ont été associés aux ÉCIM, tandis que seule la fraction d'éjection ventriculaire
gauche (RR 0,82; IC de 95 %, 0,69-0,973; P = 0,023) a été associée à la mortalité.
Conclusions
Notre étude démontre la faisabilité d'une intervention coronarienne percutanée avec
une endoprothèse à élution de médicaments chez les patients avec un SCA sans sus-décalage
du segment ST et une maladie du TCGNP. Les résultats immédiats et à long terme étaient
acceptables. La fraction d'éjection ventriculaire gauche et le score SYNTAX ≥ 33 prédisent
les ÉCIM et seule la fraction d'éjection ventriculaire gauche prédit la mortalité.
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Article info
Publication history
Published online: August 29, 2011
Accepted:
May 30,
2011
Received:
May 13,
2011
Footnotes
See page 747 for disclosure information.
Identification
Copyright
© 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
