AI Article Synopsis
- The study analyzed 998 patients who underwent percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) from 2007 to 2022, focusing on mortality predictors and trends.
- Key findings showed that older age and conditions like myocardial infarction, diabetes, and chronic obstructive pulmonary disease worsened prognosis, while higher ejection fraction and use of intravascular imaging led to better outcomes.
- Overall, the rate of LMCA PCI increased over the years, short-term mortality improved, but longer-term prognosis showed a trend toward worsening, highlighting the need to address multimorbidity in patients.
Article Abstract
Background: Percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) was endorsed by trials.
Aims: Aim was to assess prognosis and temporal trends in real-world registry.
Methods: 998 patients undergoing LMCA PCI were hospitalized from 12.27.2007 to 02.21.2022. Analysis included mortality predictors, annual and periodic trends (2007-2015 compared to 2015-2022).
Results: Median age was 71 years (IQR 16), 736 (73.8%) were male and 448 (51.9%) had multimorbidity (≥3 chronic diseases). Worse prognosis was associated with age ≥75 years (HR 1.61, 95% CI 1.17-2.20, P=0.003), myocardial infarction (HR 1.47, 95% 1.06-2.04, P=0.02), previous myocardial infarction (HR 1.43, 95% CI 1.07-1.91, P=0.02), diabetes (HR 1.38, 95% CI 1.03-1.84, P=0.03), atrial fibrillation (HR 1.74, 95% CI 1.26-2.39, P=0.001), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.27-3.20, P=0.003) and previous stroke (HR 1.78, 95% CI 1.17-2.70, P=0.007). Higher ejection fraction (HR 0.98, 95% CI 0.96-0.99, P<0.001 for 1% increase) and intravascular imaging (HR 0.70, 95% CI 0.49-1.00, P=0.047) yielded better outcomes. Rate of LMCA PCI emerged from 2.2% in 2008 to 6.9% in 2021 (P<0.001). There were increases in annual and periodic rates of multimorbidity (P<0.001), intravascular imaging (P<0.001) and decreases in 30-, 90-day (log-rank P<0.001) and 1-year mortality (log-rank P=0.007). Six-year landmark mortality analysis at 30-days showed trend toward worse prognosis in patients hospitalized in late period (log-rank P=0.051).
Conclusions: PCI and multimorbidity rates increased. Short-term mortality decreased, while prognosis beyond 30-days worsened. Advancements in PCI technology may improve early outcomes; however, efforts should be made to reduce burden of multimorbidity.
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| http://dx.doi.org/10.33963/v.phj.102774 | DOI Listing |
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