PCI & AimRadial 2018 | Experience with Left Main PCI by Radial Access - Zsolt Piróth
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Experience with Left Main PCI by Radial Access - PCI & AimRadial 2018 - Sarasota
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PCI & AimRadial 2018 | Experience with Left Main PCI by Radial Access - Zsolt Piróth
- 1. Experience with Left Main PCI by Radial Access Zsolt Piróth MD FESC Gottsegen György Hungarian Institute of Cardiology AimRadial 2018 Sarasota, Dec. 1, 2018
- 2. Background Consecutive ULMCA PCI @ HIC, 2007-2008 Piróth et al. Acta Cardiol. 2016; 71: 654-662 Survival of ULMCA PCI Predictors of 5-yr survival of aULMCA PCI Predictors of 5-yr event- free survival of aULMCA PCI
- 3. EXCEL trial: TR vs TF Non-randomized comparison Chen et al. EuroIntervention 2018; 14: 1104-1111 TR: less vessels, less lesions treated less bivalirudine 6F in most ↔ TF: 7F
- 4. EXCEL trial: TR vs TF Results I Chen et al. EuroIntervention 2018; 14: 1104-1111
- 5. EXCEL trial: TR vs TF Results II Chen et al. EuroIntervention 2018; 14: 1104-1111
- 6. EXCEL trial: TR vs TF Results III Chen et al. EuroIntervention 2018; 14: 1104-1111
- 7. Changes in PCI Over the past 10 years Radial approach became dominant FFR applied increasingly Use of IABP diminished
- 8. Aim To compare the practice and long-term outcome of ULMCA PCI of 2007-2008 (Period 1) and 2011 (Period 2) @ HIC Technique 5-year outcome Mortality MI TLR To determine the best predictor of 5-yr survival
- 9. Methods All consecutive patients undergoing ULMCA PCI at the Hungarian Institute of Cardiology between Jan. 1, 2007 and Dec. 31, 2008 (Period 1) and between Jan. 1, 2011 and Dec. 31, 2011 (Perior 2) are included in this study. The choice of devices including stents (bare metal or drug eluting (DES) stents), stenting strategy (single or two-stent technique) and the use of intra aortic balloon pumps were left to the discretion of the operator.
- 10. 5-year follow-up data concerning survival, myocardial infarction (MI), repeat revascularisation and recoronary angiography were collected using the institutional database, contacting the patients, their families, other hospitals the National Health Insurance database. Methods
- 11. 2007-2008 2011 P-value Number 76 75 Age 70 ± 11 67 ± 11 0.099 Male gender 42 (55%) 51 (68%) 0.133 Hypertension 62 (82%) 59 (79%) 0.688 Diabetes mellitus 25 (33%) 29 (39%) 0.5 Hyperlipidemia 54 (71%) 59 (79%) 0.349 S/p MI 23 (31%) 17 (23%) 0.356 S/p revascularization 17 (22%) 16 (21%) 1 GFR 61.9 ± 29.5 60.5 ± 22.9 0.697 LVEF 44.9 ± 14.0 44.5 ± 17.4 0.78 Patients
- 12. 2007-2008 2011 P-value SYNTAX score 27 ± 12 28 ± 11 0.735 Logistic EUROSCORE 25 ± 24 19 ± 19 0.135 EUROSCORE II 15 ± 17 16 ± 16 0.458 ACEF score 1.82 ± 0.82 1.88 ± 0.88 0.896 SYNTAX II PCI score 45.8 ± 15.7 44.1 ± 15.4 0.548 SYNTAX II CABG score 40.8 ± 13.3 43.9 ± 56.5 0.119 GRACE score 133 ± 39 125 ± 40 0.257 Patient scores
- 13. Procedural characteristics 2007-2008 2011 P-value Number 76 75 Left dominance 7 (9.2%) 4 (5.3%) 0.533 Codominance 6 (7.9%) 2 (2.7%) 0.276 Right dominance 63 (82.9%) 69 (92%) 0.14 Occluded dominant RCA 15 (19.7%) 9 (12%) 0.266 Stable CAD 18 (23.7%) 20 (26.7%) 0.711 NSTEACS 31 (40.8%) 31 (41.3%) 1 STEMI / CS 27 (35.5%) 24 (32%) 0.731 Distal LM PCI 59 (77.6%) 61 (81.3%) 0.688 Provisional T-stenting 46 (78%) 49 (80%) 0.725 DES 61 (80.3%) 63 (84%) 0.672
- 14. Procedural characteristics – trends 2007-2008 2011 P-value Number 76 75 Radial approach 4 (5.3%) 47 (62.7%) <0.001 IABP* 30 (39.5%) 18 (24%) 0.05 FFR-guided PCI 1 (1.3%) 10 (13.3%) 0.005 FFR-guided PCI in SCAD 1 (5.6%) 10 (50%) <0.005 Mean stent diameter 3.37 ± 0.51 3.54 ± 0.25 0.006 Stent diameter ≤ 3.0 mm 22 (28.9%) 6 (8%) 0.001 * No other form of MCS was applied
- 15. 2007-2008 2011 P-value Number 67 70 ASA 67 (100%) 69 (99%) 1 Clopidogrel 67 (100%) 70 (100%) 1 Beta blocker 58 (87%) 57 (81%) 0.489 ACEI / ARB 62 (93%) 59 (84%) 0.184 Statin 64 (96%) 68 (97%) 0.676 Medication @ D/C
- 16. 2007-2008 2011 P-value Number 76 75 5-year survival 38 (50%) 40 (53%) 0.746 Mean survival (months) 40.6 ± 29.2 44.2 ± 28.8 0.288 MI during F/U 5 (7.1%) 9 (12%) 0.404 Death ± MI during F/U 40 (52.6%) 39 (52%) 1 TLR 3 (3.9%) 5 (6.7%) 0.494 Death ± MI ± TLR during F/U 41 (53.9%) 38 (50.7%) 0.746 Death ± MI ± revasc during F/U 50 (65.8%) 42 (56%) 0.245 Mean eventfree* survival (mo) 39.0 ± 29.3 40.7 ± 29.9 0.517 * Survival free from MI, TLR 5-year outcome
- 17. Survival Event-free survival 5-year outcome
- 18. Predictors of 5-year survival After acute ULMCA PCI AUC SYNTAX II 0.76 EUROSCORE II 0.72 ACEF 0.71 EUROSCORE I 0.71 GRACE 2.0 0.69 SYNTAX 0.62
- 19. By 2011, the radial approach became dominant Left main PCI was performed twice as often in 2011 than in 2007-2008 FFR used significantly more in LM PCI Implanted stents were bigger IABP was used less Long-term outcome (death, MI, TLR, revasc.) remained unchanged. The best predictor of 5-yr survival was the SYNTAX II score. Conclusions
- 20. Small number of patients included Single center experience No intravascular imaging utilized No advanced MCS used Limitations
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