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Results of percutaneous coronary intervention of unprotected left main coronary disease in octogenarian patients

Session Poster Session 7

Speaker Maria Jose Romero Reyes

Congress : ESC Congress 2019

  • Topic : cardiovascular disease in special populations
  • Sub-topic : Cardiovascular Disease in the Elderly
  • Session type : Poster Session
  • FP Number : P6263

Authors : M J Romero Reyes (Seville,ES), A Moya Martin (Seville,ES), N Gonzalez Alemany (Seville,ES), FJ Sanchez Burguillos (Seville,ES), P Perez Santigosa (Seville,ES), S Rufian Andujar (Seville,ES), FJ Molano Casimiro (Seville,ES)

Authors:
M J Romero Reyes1 , A Moya Martin1 , N Gonzalez Alemany1 , FJ Sanchez Burguillos1 , P Perez Santigosa1 , S Rufian Andujar1 , FJ Molano Casimiro1 , 1University Hospital Virgen de Valme, Cardiology - Seville - Spain ,

Citation:

Introduction: Conservative treatment unprotected left main coronary (uLMCA) disease has a high mortality rate (50% at 3 years). Since octogenarian patients are often dismissed for surgical treatment, they tend to adopt a more conservative attitude in this population.

Purpose: We report medium and long-term outcomes of percutaneous coronary intervention (PCI) for uLCMA stenosis in elderly patients.

Methods: Retrospective cohort study of consecutive patients = 80 years with uLMCA stenosis, treated with PCI at a single center between June 2005 and February 2017.

Results: A total of 100 patients were included in the study. 58% were male, with a mean age of 83.8 ± 3 years. There were 86% hypertensive, 63% diabetic and 68% dyslipidemic. 14% of the patients had an LVEF = 35%.  Unstable angina (45%) and acute coronary syndromes withouth ST-segment elevation (44%) were the most common presentation. In 9% of the cases, cardiogenic shock was the initial presentation form. The distal left main coronary was the most frequent localitation of the lesion (46%) followed by the ostium (33%). In 63% of the cases, a multivessel coronary disease was detected and in 47% the revascularization was incomplete.

The survival rate after a year follow up was 79% and after three years follow up was 65%. However, in most of the cases the cause of death was due to other comorbidities, with cardiac death being 10% per year and 13% at 3 years of follow-up. The rate of non-fatal acute myocardial infarction was 13% per year, increasing to 20% at 3 years of follow-up. There was a 9% stent restenosis implanted at 3 years. The presence of severe left ventricular systolic dysfunction was the main predictor of mortality in long-term follow-up (OR 1.39 [95% CI 1.10-1.752], p <0.001). Incomplete revascularization was not associated with a higher mortality rate.

Conclusión: PCI is a safety option for revascularization in uLMCA stenosis in elderly patientes with excellent short-term results, as well as acceptable long-term results. Age should not be a handicap to consider uLMCA revascularization in this population.

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