Unprotected Left Main PCI at Non-Surgical Centers Not Associated With Poorer Outcomes

Although patients who presented at cardiac non-surgical centers (NSCs) had a greater acuity of illness, patients who received unprotected left main (LM) percutaneous coronary intervention (PCI) at NSCs did not have poorer clinical outcomes than those presenting at surgical centers (SCs), according to results of a study published in the American Journal of Cardiology.

Data prospectively collected for the Victorian Cardiac Outcomes Registry between 2014 and 2018 were analyzed for this study. Patients (N=730) who underwent LM PCI were assessed for clinical features, outcomes, and center type.

Patients who visited a cardiac SC or NSC were aged mean 72.3±12.0 and 69±13.1 years (P =.020); 75% and 72% were men; and BMI was 27.5±5.4 and 28.9±8.5 kg/m² (P =.020), respectively.

In addition to being younger and having increased BMI, patients who presented at NSCs had a higher incidence of using oral medications for type 2 diabetes mellitus, moderate to severe left ventricular systolic dysfunction, more had pre-procedural cardiac arrest, required pre-procedural intubation or mechanical circulatory support, and more frequently received PCI for ST-elevation myocardial infarction or cardiogenic shock (all P <.05).

The NSC cohort had more in-hospital mortality (23% vs 11%; P =.001), major adverse cardiac events (MACE; 23% vs 14%; P =.011), major adverse cardiac and cerebrovascular events (MACCE; 24% vs 15%; P =.013), and cardiogenic shock (24% vs 10%; P <.001). Similarly, the NSC cohort had higher rates of 30-day mortality (24% vs 12%; P <.001), MACE (26% vs 16%; P =.004), and MACCE (27% vs 16%; P =.003).

In the multivariate analysis, onsite cardiac surgery did not predict in-hospital mortality (odds ratio [OR], 0.68; 95% CI, 0.32-1.43; P =.31), 30-day mortality (OR, 0.70; 95% CI, 0.33-1.48; P =.35), or long-term mortality (hazard ratio [HR], 0.88; 95% CI, 0.62-1.27; P =.51).

Similar trends were observed among the subgroup of patients who were hemodynamically stable and in a propensity score analysis.

This study was limited by not assessing for outcomes among patients who received medical management due to lack of surgical access.

Despite greater severity of illness in patients receiving unprotected LM PCI at NSCs, “the availability of onsite surgical support did not independently predict in-hospital, 30-day, or long-term outcomes underscoring the feasibility, and safety of LM PCI in NSCs,” the researchers wrote. “Larger studies and possibly a randomized-controlled trial evaluating the safety and efficacy of unprotected LM PCI in an all-comers population at NSCs versus SCs appear warranted.”

Reference

Hanson L, Vogrin S, Noaman S, et al. Long-Term Outcomes of Unprotected left main percutaneous coronary intervention in centers without onsite cardiac surgery. Am J Cardiol. Published online January 31, 2022. doi:10.1016/j.amjcard.2021.12.051