Left Main Coronary Artery Disease and Outcomes after Percutaneous Coronary Intervention for Chronic Total Occlusions
Abstract
:1. Introduction
2. Methods
2.1. Study Population
2.2. Procedural Characteristics
2.3. Clinical Measures and Follow-Up
2.4. Statistical Methods
3. Results
3.1. Baseline Characteristics
3.2. Clinical Characteristics According to Left Main Coronary Artery Disease
3.3. Left Main Coronary Artery Disease and Outcome
3.4. Left Main Coronary Artery Disease and Outcome According to Target Vessel
4. Discussion
4.1. Risk Profile of Left Main Coronary Artery Disease in CTO Patients
4.2. Long Term Clinical Outcomes in Patients with Left Main Coronary Artery Disease
4.3. Outcomes in Patients with Left Main Coronary Artery Disease According to Target Vessel
4.4. Limitations
5. Conclusions
Author Contributions
Conflicts of Interest
References
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Total Study Population (n = 3860) | LMCA Disease (n = 604) | No LMCA (n = 3256) | p-Value | |
---|---|---|---|---|
Baseline Characteristics | ||||
Age, median years (IQR) | 66 (57–74) | 68 (60–75) | 65 (57–73) | <0.001 |
Male sex, n (%) | 3218 (83) | 517 (86) | 2701 (83) | 0.116 |
BMI, kg/m2(IQR) | 27.8 (25.2–30.7) | 27.8 (25.4–30.9) | 27.7 (25.2–30.6) | 0.742 |
Smoking, n (%) | 731 (19) | 83 (14) | 648 (20) | <0.001 |
Hypertension, n (%) | 3202 (83) | 533 (88) | 2669 (82) | 0.001 |
Diabetes, n (%) | 1111 (29) | 199 (33) | 912 (28) | 0.036 |
Hypercholesterolemia, n (%) | 3270 (85) | 522 (86) | 2748 (84) | 0.953 |
Family history of CAD, n (%) | 1410 (37) | 231(38) | 1179 (36) | 0.839 |
Previous myocardial infarction, n (%) | 1161 (30) | 194 (32) | 967 (30) | 0.466 |
Previous CABG, n (%) | 594 (15) | 162 (27) | 432 (13) | <0.001 |
Previous PCI, n (%) | 645 (17) | 121 (20) | 524 (16) | 0.017 |
NYHA functional class | 0.235 | |||
NYHA II | 1444 (37) | 218 (36) | 1226 (38) | |
NYHA III | 838 (22) | 147 (24) | 691 (21) | |
NYHA IV | 123 (3) | 19 (3) | 104 (3) | |
CCS class | 0.473 | |||
CCS II | 1143 (30) | 186 (31) | 957 (30) | |
CCS III | 847 (22) | 127 (21) | 720 (22) | |
CCS IV | 615 (16) | 108 (18) | 507 (16) | |
Reduced LV function (LVEF < 40%), n (%) | 242 (6) | 48 (8) | 194 (6) | 0.102 |
J-CTO score (IQR) | 2 (1–3) | 2 (1–3) | 2 (1–3) | <0.001 |
Creatinine, mg/dL (IQR) | 1.0 (0.9–1.2) | 1.0 (0.9–1.2) | 1.0 (0.9–1.1) | 0.114 |
LDL cholesterol, mg/dL (IQR) | 108 (83–139) | 106 (82–139) | 108 (84–139) | 0.682 |
HDL cholesterol, mg/dL (IQR) | 47 (39–56) | 47 (39–54) | 47 (39–57) | 0.746 |
Hemoglobin (g/dL), median (IQR) | 14.4 (13.4–15.3) | 14.3 (13. 1–15.2) | 14.4 (13.4–15.3) | 0.019 |
Retrograde approach, n (%) | 987 (26) | 168 (28) | 819 (25) | 0.178 |
Extensive coronary calcification, n (%) | 1087 (28) | 202 (33) | 885 (27) | <0.001 |
Amount of contrast dye used (mL), median (IQR) | 300 (200–400) | 300 (220–420) | 300 (200–400) | 0.008 |
Nominal stent diameter (mm), median (IQR) | 3.00 (2.75–3.50) | 3.00 (2.75–3.50) | 3.00 (2.75–3.50) | 0.267 |
Concomitant RCA disease, n (%) | 1800 (46.6) | 271 (44.9) | 1529 (47) | 0.344 |
Procedural success n (%) | 3257 (84) | 494 (82) | 2763 (85) | 0.056 |
Univariable Model | Multivariable Model * | Bootstrap-Adjusted Confounder Model † | ||||
---|---|---|---|---|---|---|
All-Cause Mortality | Crude HR (95% CI) | p-Value | Adj. HR (95% CI) | p-Value | Adj. HR (95% CI) | p-Value |
LMCA disease | 1.59 (1.23–2.04) | <0.001 | 1.32 (1.006–1.73) | 0.045 | 1.32 (1.03–1.70) | 0.031 |
Secondary Endpoint | ||||||
LMCA disease | 1.39 (1.18–1.63) | <0.001 | 1.25 (1.06–1.48) | 0.009 | 1.33 (1.14–1.57) | <0.001 |
Univariable Model | Multivariable Model * | Bootstrap-Adjusted Confounder Model † | ||||
---|---|---|---|---|---|---|
Crude HR (95% CI) | p-Value | Adj. HR (95% CI) | p-Value | Adj. HR (95% CI) | p-Value | |
LAD-CTO | 1.41 (0.86–2.31) | 0.175 | 1.30 (0.76–2.24) | 0.338 | 1.15 (0.70–1.90) | 0.581 |
RCA-CTO | 1.59 (1.08- 2.35) | 0.018 | 1.32 (0.87–2.01) | 0.197 | 1.17 (0.79–1.73) | 0.448 |
CX-CTO | 1.99 (1.26–3.14) | 0.005 | 1.65 (1.02–2.68) | 0.042 | 2.01 (1.27–3.16) | 0.003 |
Univariable Model | Multivariable Model * | Bootstrap-Adjusted Confounder Model † | ||||
---|---|---|---|---|---|---|
Crude HR (95%CI) | p-Value | Adj. HR (95%CI) | p-Value | Adj. HR (95%CI) | p-Value | |
LAD-CTO | 1.24 (0.90–1.72) | 0.189 | 1.12 (0.80–1.58) | 0.509 | 1.26 (0.98–1.61) | 0.069 |
RCA-CTO | 1.36 (1.06–1.74) | 0.014 | 1.16 (0.89–1.50) | 0.263 | 1.17 (0.84–1.62) | 0.351 |
CX-CTO | 1.72 (1.28–2.32) | <0.001 | 1.75 (1.28–2.34) | <0.001 | 1.78 (1.32–2.39) | <0.001 |
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Winter, M.-P.; Goliasch, G.; Bartko, P.; Siller-Matula, J.; Ayoub, M.; Aschauer, S.; Distelmaier, K.; Gebhard, C.; Mashayekhi, K.; Ferenc, M.; et al. Left Main Coronary Artery Disease and Outcomes after Percutaneous Coronary Intervention for Chronic Total Occlusions. J. Clin. Med. 2020, 9, 938. https://doi.org/10.3390/jcm9040938
Winter M-P, Goliasch G, Bartko P, Siller-Matula J, Ayoub M, Aschauer S, Distelmaier K, Gebhard C, Mashayekhi K, Ferenc M, et al. Left Main Coronary Artery Disease and Outcomes after Percutaneous Coronary Intervention for Chronic Total Occlusions. Journal of Clinical Medicine. 2020; 9(4):938. https://doi.org/10.3390/jcm9040938
Chicago/Turabian StyleWinter, Max-Paul, Georg Goliasch, Philipp Bartko, Jolanta Siller-Matula, Mohamed Ayoub, Stefan Aschauer, Klaus Distelmaier, Catherine Gebhard, Kambis Mashayekhi, Miroslaw Ferenc, and et al. 2020. "Left Main Coronary Artery Disease and Outcomes after Percutaneous Coronary Intervention for Chronic Total Occlusions" Journal of Clinical Medicine 9, no. 4: 938. https://doi.org/10.3390/jcm9040938