Unprotected left main (LM) percutaneous coronary intervention (PCI) at centers without
onsite cardiac surgery remains controversial. We aimed to evaluate the effect of onsite
cardiac surgery on short-term and long-term outcomes in patients who had unprotected
LM PCI. We analyzed Victorian Cardiac Outcomes Registry data on consecutive patients
who had unprotected LM PCI at cardiac surgical centers (SCs) and non-SCs (NSCs) between
January 2014 to December 2018. Compared with the SC group (n = 594, 81%), the NSC
group (n = 136) were younger (69 vs 72 years) and presented with more ST-elevation
myocardial infarction (35% vs 16%) and cardiogenic shock (25% vs 15%), with higher
rates of preprocedural intubation (17% vs 11%) and mechanical circulatory support
(20% vs 9.3%), all p <0.01. Unadjusted in-hospital mortality (23% vs 11.4%), and 30-day
major adverse cardiac events (composite of mortality, myocardial infarction, stent
thrombosis, or unplanned revascularization) (26% vs 16%) were higher in NSC patients,
all p <0.01. However, following multivariable adjustment, SC was neither a predictor
of in-hospital mortality (odds ratio 0.68, 95% confidence interval [CI] 0.32 to 1.43,
p = 0.31), 30-day mortality (odds ratio 0.70, 95% CI 0.33 to 1.48, p = 0.35) nor long-term
survival at 60 months (hazard ratio 0.88, 95% CI 0.62 to 1.27, p = 0.51). Propensity
score analysis confirmed the neutral effect of onsite cardiac surgery on long-term
survival (hazard ratio 0.99, 95% CI 0.66 to 1.50, p = 0.97). In conclusion, patients
who underwent unprotected LM PCI at NSCs presented with greater acuity of illness.
Despite this, the availability of onsite cardiac surgical support was not associated
with in-hospital, 30-day, or long-term outcomes underscoring the safety of LM PCI
in NSCs.
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Article info
Publication history
Published online: January 31, 2022
Received in revised form:
December 10,
2021
Received:
September 29,
2021
Footnotes
A/Prof Stub's work is supported by National Heart foundation fellowship, GNT 101908. Prof. Duffy's work is supported by a National Health and Medical Research Council of Australia (Canberra, Australia) ], GNT 1111170. Prof. Reid's work is supported by mixed National Health and Medical Research Council (Canberra, Australia) Principal Research Fellowship, GNT 1136372.
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