scholarly journals The Impact of Smoking Status on the Long-Term Prognosis of Male Patients Underwent Percutaneous Coronary Intervention of Left Main Coronary Artery

2020 ◽  
Author(s):  
Shu-bin QIAO ◽  
TENG Hao-bo ◽  
GUO Chao ◽  
GUAN Chang-dong ◽  
WANG Xin-yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Main Coronary Artery ◽  
Smoking Status ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Target Vessel ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Male Patients ◽  
Target Lesion Failure

Abstract Objective: To evaluate the impact of smoking status on the long-term prognosis of male patients with left main coronary artery lesions who received percutaneous coronary intervention. Methods: A retrospective analysis was conducted. A total of 3122 male patients with left main lesions who received percutaneous coronary intervention in our hospital were categorized by smoking status at admission: 1207 in the non-smokers group, 1339 in the current smokers group, and 576 in the ex-smokers group. The patients were followed up for 3 years. The main study endpoints were major cardiovascular adverse events (composite endpoints of all-cause death, all myocardial infarctions and revascularization) and target lesion failure (composite endpoints of cardiogenic death, target vessel-related myocardial infarction, target vessel-related blood flow reconstruction). Results: The patients in the current smokers group was younger than the non-smokers group and the ex-smokers group (p<0.0001). In terms of prognosis, no statistical significance observed in the incidence of composite end point of MACE (p=0.9866), target lesion failure (p=0.2522), and stent thrombosis (p=0.2118), all-cause death (p=0.3130), cardiogenic death (p=0.2509), revascularization (p=0.5028), target vessel-related revascularization (p=0.9866), and stroke (p=0.3895), among the three groups. The current smokers group had the lowest incidence of myocardial infarction while ex-smokers group had the highest incidence rate(5.67%vs.5.10%vs.2.97%,p=0.0072), and so is the incidence of myocardial infarction related to target vessels (5.48%vs.5.10%vs.2.89%,p=0.0067). According to Cox regression analysis, history of myocardial infarction(HR=1.339，95%CI：1.042-1.722，p=0.0227), and baseline SYNTAX score(HR=1.0333, 95%CI:1.017-1.049,p<0.0001) are independent risk factors of MACE, while current smoking(HR=0.793,95%CI：0.646-0.974,p=0.0274) proves to be an independent protective factor of target vessel related myocardial infarction. Conclusion: For male patients with the left main coronary artery lesions receiving PCI, smoking has no impact on the long-term MACE or target lesion failure, current smoking is an independent protective factor for target vessel related myocardial infarction.

scholarly journals Two-Year Outcomes after Left Main Coronary Artery Percutaneous Coronary Intervention in Patients Presenting with Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Si-Da Jia ◽  
Yi Yao ◽  
Ying Song ◽  
Xiao-Fang Tang ◽  
Xue-Yan Zhao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Left Main ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objectives. We aim to evaluate long-term outcomes after left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). Background. PCI of the LMCA has been an acceptable revascularization strategy in stable coronary artery disease. However, limited studies on long-term clinical outcomes of LMCA PCI in ACS patients are available. Methods. A total of 6429 consecutive patients with ACS undergoing PCI in Fuwai Hospital in 2013 were enrolled. Patients are divided into LMCA group and Non-LMCA group according to whether the target lesion was located in LMCA. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results. 155 (2.4%) patients had target lesion in LMCA, while 6274 (97.6%) patients belong to the non-LMCA group. Compared with non-LMCA patients, LMCA patients have generally more comorbidities and worse baseline conditions. Two-year follow-up reveals that LMCA patients have significantly higher rate of cardiac death (2.6% vs. 0.7%, p=0.034), myocardial infarction (7.1% vs. 1.8%, p<0.001), in-stent thrombosis (4.5% vs. 0.8%, p<0.001), and stroke (7.1% vs. 6.4%, p=0.025). After adjusting for confounding factors, LMCA remains independently associated with higher 2-year myocardial infarction rate (HR = 2.585, 95% CI = 1.243–5.347, p=0.011). Conclusion. LMCA-targeted PCI is an independent risk factor for 2-year myocardial infarction in ACS patients.

scholarly journals Clinical Implications of Bifurcation Angles in Left Main Bifurcation Intervention Using a Two-Stent Technique

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
You-Jeong Ki ◽  
Ji Hyun Jung ◽  
Jung-Kyu Han ◽  
Sukkeun Hong ◽  
Jang Hyun Cho ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Group A ◽  
Drug Eluting ◽  
Target Lesion Failure ◽  
The Impact

Objectives. The aim of this study was to assess the clinical impact of 3 bifurcation angles in left main (LM) bifurcation treated with the 2-stent technique. Background. Data are limited regarding the impact of bifurcation angles after LM percutaneous coronary intervention (PCI). Methods. Using patient-level 4 multicenter registries in Korea, 462 patients undergoing LM bifurcation PCI with the 2-stent technique were identified (181 crush, 167 T-stenting; 63% 1st generation drug-eluting stent (DES), 37% 2nd generation DES). Three bifurcation angles, between the LM and left anterior descending (LAD), the LM and left circumflex (LCX), and the LAD and LCX, were measured. The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR). Results. In patients treated with the crush technique, the best cutoff value (BCV) to predict TLF was 152° of the LM-LAD angle. In the crush group, a significantly higher TLF rate, mostly driven by TLR, was observed in the LM-LAD angle ≥152° group compared with the <152° group (35.7% vs. 14.6%; adjusted hazard ratio 3.476; 95% confidence interval 1.612–7.492). An LM-LAD angle ≥152° was an independent predictor of TLF. In the T-stenting, no bifurcation angle affected the clinical outcomes. Conclusions. In LM bifurcation PCI using the 2-stent technique, wide LM-LAD angle (≥152°) was associated with a greater risk of TLF in the crush, whereas none of the bifurcation angles affected T-stenting outcomes.

The acutely occluded left main coronary artery culprit in cardiogenic shock and initial percutaneous coronary intervention: a substudy of the Manitoba “no option” left main PCI registry

2012 ◽  
Vol 90 (9) ◽  
pp. 1325-1331 ◽  
Author(s):  
Farrukh Hussain ◽  
Thang Nguyen ◽  
Nader Elmayergi ◽  
John Ducas ◽  
Kunal Minhas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Cardiogenic Shock ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Ventricular Assist Devices ◽  
Left Main ◽  
Percutaneous Coronary ◽  
The Mean

We aim to describe the in-hospital outcomes of the first reported Canadian cohort of patients with cardiogenic shock and acute myocardial infarction (MI) due to acute and total occlusion of the left main coronary artery, treated with initial percutaneous coronary intervention (PCI). Acute left main thromboses with cardiogenic shock were identified (N = 8) from a retrospective consecutive cohort of high risk left main PCI (N = 56) performed at our institution from 2004–2009. The mean age was 62.3 ± 13.2 years, with 6 (75%) male patients. Successful PCI was performed in all patients, with thrombectomy utilized in 4 patients (50%), stenting in 7 patients (88%), and intra-aortic balloon pump augmentation in 7 patients (88%). Two patients (25%) required extracorporeal membrane oxygenation (ECMO) and 2 other patients required ventricular assist devices. Post-PCI coronary artery bypass grafting (CABG) was performed for 2 patients (25%). The mean SYNTAX score was 26.6 ± 10.5. The mean logistic EuroSCORE was 30.4 ± 12.6%. In-hospital mortality occurred in 3 patients (38%). Acute left main occlusion is a rare but devastating presentation of myocardial infarction, invariably with cardiogenic shock. Emergent PCI may be an effective method to acutely revascularize this subset of patients; however, aggressive post-PCI care including ECMO, CABG, and ventricular support may be required to improve patient survival.

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