Doctor & Patient Education Cardiac Specialist Centre
Intervention
17. Asia PCR Presentation - Result of 7 years follow up post Left Main Stenting

Left Main stenting
  • Stenting of narrowed or blocked coronary arteries is a common and relatively easy procedure
  • However, stenting of the Left Main requires more experience and expertise as mishaps may result in unacceptable complication or death
  • I have been doing Left Main stenting since 2007
  • We have been collecting these cases and follow up with their progress
  • In more recent years, my colleagues in Changi General Hospital also contributed cases into our follow up series
  • In January of 2016, we have the privilege of presenting our results in the Asia PCR/SingLive conference
  • This is one of largest series and longest follow up coming out of Singapore with a maximum follow up of 7 years
  • I am pleased to say that our results are comparable to those of international standard
  • The following slides were presented by Dr. Mathew Liew at the meeting with minor edits

Outcome of unprotected left main coronary artery percutaneous coronary intervention: Single centre longitudinal follow up study

Background

  • There has been increasing data regarding PCI of the unprotected left main coronary artery (ULMCA) and their outcomes. However there is a lack of data on the longer term outcomes in our local population following such intervention.
  • Aim: To evaluate the long term outcomes of patients who underwent unprotected left main PCI in our local population
Method
  • A retrospective analysis of all ULMCA PCI cases that were performed from 2007 to 2013
    • on an urgent basis
    • had refused surgical revascularization
  • Baseline demographics and follow up outcomes were collected
  • Mean follow up period was 3 years (range = 3 to 7 years)
  • Multivariate analysis was performed using the statistic program SPSS version 19 to identify potential predictors of adverse outcomes

Elective vs unplanned LM PCI
  • In the elective PCI group:
    • More frequent femoral use (93.3% vs 56.5%)
    • No IABP inserted
    • Fewer patients with EF <40% (20.5% vs 56.5%)
    • Fewer patients with Medina (1,1,1) anatomy (11.1% vs 30.4%)
    • Fewer patients with Euroscore >5 (40% vs 82.6%)

Results

  • Overall MACE rates: 11.8% (8 out of 68 cases)
    • Death: 10.3%
    • Target lesion revascularisation: 1.5%

  • Elective PCI: 6.6%
    • 2 deaths (4.4%) out of 45 patients
    • Of which one was sepsis, and one was sudden death
    • 1 target lesion revascularisation (2.2%)


Results

Non-elective PCI: 42.5%
  • 5 deaths
    • Acute LM occlusion cases (5 out of 11, 42.5%)
    • Presented with cardiogenic shock

Results
  • Use of IABP (P = 0.05) (patients in cardiogenic shock) and low ejection fraction (<40%) (p = 0.04) were independent predictors of MACE at 3years.
  • High Syntax score, use of DES, 1 vs 2 stent technique did not predict MACE at 3 years.

Discussion
  • There is small number of subjects
    • However, this has a long follow up period
  • Lower rate of re-look angiogram
    • This implies that there was low clinical events
  • Overall MACE in elective arm was low
  • There was only 1 case of ISR requiring revascularization

CONCLUSION
  • The incidence of adverse events associated with unprotected left main coronary artery stenting is low
    • Mitigated by better stent technology, better antithrombotic options, imaging adjuncts
  • Predictors of adverse events in our centre are the use of IABP (cardiogenic shock) and presence of low ejection fraction
Consultation
Know Your Cardiologists

I feel breathless when walking.

I feel a tightness over my chest.

Do I need to take my medicine for my blood pressure?

Do I need to take my medicine for my cholesterol?

Do I really need stents for my artery?

Do I really need to have a bypass operation?

When should I go for health screening?

I have heart problem, can I take Viagra?

I have heart problem, should I exercise?

Heart Disease
Learn about your heart Conditions

You may need an ultra sound scan of your heart to assess its function.

You may need a treadmill stress test.

You may need closer monitoring.

You may need a more thorough risk assessment and life style change.

You may only need to take your medicine.

You may get away with just stenting.

This generally should start at 40 years old.

Yes, but there are certain strict conditions to fulfill.

Yes, but you will need to find out the appropriate intensity.