open access

Vol 79, No 6 (2021)
Original article
Published online: 2021-04-26
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The impact of right coronary artery support on outcomes of patients with unprotected left main disease undergoing percutaneous coronary intervention

Wojciech Jan Skorupski, Marek Grygier, Aleksander Araszkiewicz, Włodzimierz Skorupski, Stefan Grajek, Małgorzata Pyda, Andrzej Siniawski, Przemysław Mitkowski, Maciej Lesiak, Marta Kałużna-Oleksy
DOI: 10.33963/KP.15972
·
Pubmed: 33909388
·
Kardiol Pol 2021;79(6):631-637.

open access

Vol 79, No 6 (2021)
Original article
Published online: 2021-04-26

Abstract

Background: Many operators are discouraged from performing left main (LM) percutaneous coronary interventions (PCI) in the absence of right coronary artery (RCA) support due to the increased procedure risk. Aims: We aimed at assessing the impact of absent functional RCA on prognostic implications in patients undergoing unprotected LM PCI. Methods: 613 patients underwent LM PCI in our department between 2015 and 2019. Consecutive 385 patients with unprotected LM and at least 1-year follow-up were included in the study. The study population comprised 272 patients with unprotected left main coronary artery disease (ULMCAD) with dominant RCA, without any significant lesions (Group 1), and 113 ULMCAD patients and without RCA support (Group 2). Results: In Group 2, 32.7% patients had a significant RCA stenosis, 48.7% had chronic total occlusion (CTO) of RCA, and 18.6% had recessive RCA. Patients in Group 2 were older and had higher prevalence of chronic obstructive pulmonary disease (COPD). SYNTAX Score (median [IQR] 26.0 [20.0–33.0] vs 19.0 [13.0–25.5]; P < 0.001) was higher and left ventricular ejection fraction was lower (median [IQR] 50.0 [40.0–60.0]% vs 55.0 [45.0–60.0]%; P = 0.01) in this group. All periprocedural complications did not differ among the groups. Long-term all-cause mortality at a median follow-up of 1149 days did not differ significantly (23% vs 20%; P = 0.37). The long-term mortality in CTO-RCA group was also not significantly different. Conclusions: Patients with ULMCAD who have undergone LM PCI in the absence of RCA support, compared with those with ULMCAD and RCA support, differed neither in the prevalence of periprocedural complications nor in long-term all-cause mortality.

Abstract

Background: Many operators are discouraged from performing left main (LM) percutaneous coronary interventions (PCI) in the absence of right coronary artery (RCA) support due to the increased procedure risk. Aims: We aimed at assessing the impact of absent functional RCA on prognostic implications in patients undergoing unprotected LM PCI. Methods: 613 patients underwent LM PCI in our department between 2015 and 2019. Consecutive 385 patients with unprotected LM and at least 1-year follow-up were included in the study. The study population comprised 272 patients with unprotected left main coronary artery disease (ULMCAD) with dominant RCA, without any significant lesions (Group 1), and 113 ULMCAD patients and without RCA support (Group 2). Results: In Group 2, 32.7% patients had a significant RCA stenosis, 48.7% had chronic total occlusion (CTO) of RCA, and 18.6% had recessive RCA. Patients in Group 2 were older and had higher prevalence of chronic obstructive pulmonary disease (COPD). SYNTAX Score (median [IQR] 26.0 [20.0–33.0] vs 19.0 [13.0–25.5]; P < 0.001) was higher and left ventricular ejection fraction was lower (median [IQR] 50.0 [40.0–60.0]% vs 55.0 [45.0–60.0]%; P = 0.01) in this group. All periprocedural complications did not differ among the groups. Long-term all-cause mortality at a median follow-up of 1149 days did not differ significantly (23% vs 20%; P = 0.37). The long-term mortality in CTO-RCA group was also not significantly different. Conclusions: Patients with ULMCAD who have undergone LM PCI in the absence of RCA support, compared with those with ULMCAD and RCA support, differed neither in the prevalence of periprocedural complications nor in long-term all-cause mortality.

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Keywords

left main, percutaneous coronary intervention, right coronary artery support

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About this article
Title

The impact of right coronary artery support on outcomes of patients with unprotected left main disease undergoing percutaneous coronary intervention

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 79, No 6 (2021)

Article type

Original article

Pages

631-637

Published online

2021-04-26

DOI

10.33963/KP.15972

Pubmed

33909388

Bibliographic record

Kardiol Pol 2021;79(6):631-637.

Keywords

left main
percutaneous coronary intervention
right coronary artery support

Authors

Wojciech Jan Skorupski
Marek Grygier
Aleksander Araszkiewicz
Włodzimierz Skorupski
Stefan Grajek
Małgorzata Pyda
Andrzej Siniawski
Przemysław Mitkowski
Maciej Lesiak
Marta Kałużna-Oleksy

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