Download Abstract: P767 Left main coronary artery disease in non st segment

Abstract: P767
Left main coronary artery disease in non st segment elevation myocardial infarction: impact in in­
hospital morbidity and mortality
Authors:
K Hyde Congo 1, JF Carvalho 1, D Neves 1, B Picarra 1, AR Santos 1, J Aguiar 1, R Rnsca 2, 1Hospital Espirito
Santo de Evora, Cardiology ­ Evora ­ Portugal, 2Centro Nacional de Coleção de Dados
­ Coimbra ­ Portugal,
On behalf: RNSCA
Topic(s):
Acute coronary syndrome ­ Non ST­elevation myocardial infarction
Citation: European Heart Journal Supplement ( 2010 ) 12 ( Supplement F ), F362
Introduction: Unlike stable coronary disease, approach to left main coronary artery (LMCA) disease in non­ST
segment elevation myocardial infarction (NSTEMI) still lacks evidence in latest recommendations.
Purpose: Determine the prevalence of LMCA disease in NSTEMI and assess the impact of percutaneous
coronary intervention (PCI) in in­hospital morbidity and mortality.
Methods: We considered 3173 patients (P) with NSTEMI, submitted to coronary angiography and analyzed
those with LMCA stenosis ≥50%. We considered 2 groups: Group 1­ P submitted to PCI of LMCA; Group
2­ P not submitted to PCI LMCA. We registered data concerning demographic features, patient history
including cardiovascular and non­cardiovascular co­morbidities, class of Killip­Kimball at hospital admission,
coronary anatomy, number of vessels subjected to PCI, type of stent, medical therapy and left ventricular
function. We considered the following in­hospital complications: re­infarction, heart failure (HF), stroke, major
bleeding and in­hospital mortality. We performed multivariate data analysis to assess independent predictor
factors for LMCA PCI.
Results: LMCA disease was found in 10.4% (331 P) and 17.5% of these (58 P) were subjected to LMCA
PCI. No differences were found concerning age, gender or patient history between the 2 groups. At hospital
admission P from group 1 presented higher classes of KK (KK≥2: 37.9% vs 26.1%; p=0.015). During
hospital stay, P from group 1 were more frequently treated with clopidogrel (100% vs 91.2%, p=0.021),
glycoprotein IIb/IIIa antagonists (24.1% vs 8.1%; p<0.001), heparin (29.8% vs 14.1%; p= 0.004) and
calcium channel blockers (26.3% vs 10.3%; p=0.001). In addition to LMCA disease, P in group 1 presented
less frequently right coronary and left circumflex disease (58.9% vs 76.5%; p=0.007 and 62.5 vs 76.1%;
p=0.035, respectively), although no differences were found in total number of affected vessels. Simultaneously
with LMCA PCI, P from group 1 more frequently underwent PCI of left anterior descending artery (48.3% vs
17.1%; p=0.003) and implanted drug­eluting stents (86.2% vs 28.6%; p< 0.001). No differences were found
in duration of hospital stay, left ventricular function or any of the considered complications. In­hospital mortality
was similar in both groups (group 1: 1.7%; group 2: 4.8%; p=0.43). By multivariate data analysis the most
important independent factor for LMCA PCI was the presence of isolated LMCA disease at coronary
angiography [OR: 5.07 (2.05­12.5); p<0.001].
Conclusions: The prevalence of LMCA disease was 10.4% in NSTEMI patients. LMCA PCI in these patients
appears to be safe as it was not associated with an increase in mortality or complications. Isolated LMCA
disease was found as the most important independent factor for LMCA PCI.