Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
Catheter Cardiovasc Interv. 2020 Feb 15;95(3):515-521. doi: 10.1002/ccd.28404. Epub 2019 Jul 26.
Percutaneous coronary intervention (PCI) of left main (LM) disease in patients with cardiogenic shock (CS) represents a clinical challenge. Evidence on clinical outcomes according to revascularization strategies in this scenario remains scarce. The objective was to investigate the short-term outcomes according to treatment strategies for this population.
We retrospectively analyzed 78 consecutive patients who underwent PCI of LM in established CS at two experienced centers. Characteristics of PCI and short-term clinical outcomes were assessed.
LM stenosis was considered the culprit lesion in 49 patients (62.8%). In the remaining cases, LM stenosis was treated after successful PCI of the culprit vessel because of persistent CS. The majority of patients presented complex coronary anatomy (43.6% had Syntax score > 32). Complete revascularization was performed in 34.6%; a 2-stents technique in the LM bifurcation was used in 12.8% and intra-aortic balloon pump (IABP) in 73.1%. In-hospital mortality was 48.7%. At 90 days follow-up it was 50% without differences between 1 or 2 stent LM bifurcation-techniques (p = .319). Mortality was higher in patients with partial revascularization and residual Syntax score ≥ 15 (p < .05 by univariate analysis), and in those with TIMI flow<3 in the left coronary artery at the end of PCI (p < .05 by multivariate analysis). There were no significant differences in the use of IABP in relation to 90-day mortality (p = .92).
In patients presenting with cardiogenic shock and LM disease, neither 2-stents strategy in the LM nor use of IABP displayed a reduced short-term mortality. However, patients with final TIMI flow <3 presented higher short-term mortality in our series.
在伴有心源性休克（CS）的患者中行左主干（LM）病变经皮冠状动脉介入治疗（PCI）代表了一项临床挑战。关于在此种情况下再血管化策略的临床结果的证据仍然很少。本研究旨在根据该人群的治疗策略来探讨短期结果。
我们回顾性分析了在两个经验丰富的中心，78 例连续接受 LM 经皮冠状动脉介入治疗的伴有 CS 的患者。评估了 LM 经皮冠状动脉介入治疗的特点和短期临床结果。
49 例（62.8%）患者 LM 狭窄被认为是罪犯病变。在其余情况下，由于 CS 持续存在，在成功进行罪犯血管 PCI 后，对 LM 狭窄进行了治疗。大多数患者存在复杂的冠状动脉解剖结构（43.6%的患者Syntax 评分>32）。34.6%的患者进行了完全血运重建；12.8%的患者在 LM 分叉处使用 2 个支架技术，73.1%的患者使用主动脉内球囊泵（IABP）。住院死亡率为 48.7%。90 天随访时死亡率为 50%，1 个或 2 个支架 LM 分叉技术之间无差异（p = 0.319）。在部分血运重建和残留 Syntax 评分≥15的患者中，以及在 PCI 结束时左冠状动脉 TIMI 血流<3的患者中，死亡率更高（单因素分析，p < 0.05），在多因素分析中，TIMI 血流<3 的患者死亡率更高（p < 0.05）。在 90 天死亡率方面，IABP 的使用无显著差异（p = 0.92）。
在伴有心源性休克和 LM 疾病的患者中，LM 中的 2 个支架策略和使用 IABP 均未降低短期死亡率。然而，在我们的研究中，最终 TIMI 血流<3 的患者短期死亡率更高。
