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The Polish Left Main Coronary DiseaseRegistry (POLEMICA)
Pawel Buszman, MD, FESC, FACC, FSCAI
Upper Silesian Heart CenterSilesian Medical University
Katowice, Poland
TCT Asia TCT Asia PacificPacific 20092009
Presenter Disclosure Information
• Chairman of the Executive Board and co-owner, American Heart of Poland Inc.
• Shares’ holder of NAFIS Inc, Intercard Inc.• Chairman of Scientific Committee and Advisory
Board, Balton Ltd
POLEMICA:POLEMICA:PolishPolish LeftLeft MainMain CoronaryCoronary ArteryArteryDiseaseDisease RegistryRegistry
AIM:
• To describe the prevalence and clinicalpresentation of left main coronaryartery disease in Poland.
• To evaluate current trends in treatmentof left main coronary artery disease andits short and late outcome.
METHODS• The registry has been created as a sub-analysis added to
national, electronic Data Base of Polish Cardiac Society andPolish Society of Cardiothoracic Surgery
• The data collected from 43 cath labs in Poland Total: between Nov. 2005-Dec 2008: 5 196 ptsI stage: between Nov 2005 and Dec 2006: 1647 pts
Total : 5196
SASTEMINSTEMI
ConsPCICABG
38%38%
19%19%
43%43%
6%6%
32%32%58%58%
PreliminaryPreliminary resultsresults: :
712; 43%
313; 19%622; 38%
SA
NST-ACS
STEMI
N=1647N=1647 ptspts withwith LMCAD (>50% DS) LMCAD (>50% DS) 2.5% 2.5% ofof ptspts undergoingundergoing coronarycoronary angiographyangiography
Intention to treatmentIntentionIntention to to treatmenttreatment
0%
20%
40%
60%
80%
100%
SA NST-ACS STEMI
RxCABGPCI
72,8%
18.7%
8%
68,8%
5%
26,1%
3,8%
24,9%
71,2%
IndexIndex ProcedureProcedure
0%
20%
40%
60%
80%
100%
SA NST-ACS STEMI
RxCABGPCI-LM
50,2%
38,7%
11,1%
48,5%
33,5%
24,0%39,9%
24%
36,1%
Comparison of patients’ cohorts:LM-PCI vs CABG vs Rx
7,7%2,8%26,4%Killip IV
11,1%3,3%14%LVEF<30
62,7%1,74%66,7%Euroscore>6
31%50%11%Stableangina
67,766,365,5Age
RxCABGLM-PCIRisk factors
Factors influencing treatment selectionIndex procedure : PCI vs CABG
1CABG PCI
3 (1,4-6,2)
0,7 (0,7-0,8)
1,02 (1-1,02)
6 (2,8-15)
0,2 (0,1-0,4)12 (6,9-28)
0,5 (0,3-0,7)
3,4 (2-5)
3(1,8-6)
47 (20-07)
0,3 (0,2-0,5)2,7 (1,4-5,2)2,7 (1,7-4,3)
0,3 (0,2-0,5)
OR (95% CI)
Stroke 3,7 (1,7-8)13,6 (6,5-28)
1,05 (1,02-1,08)
0
Euroscore
Anemia
% of stenosi
EV<30%
multi vessel disease
STEMI
NSTEMI
manpost PCI
post CABGBifucation
Pulmonary hypertension
Peripheral artetydisease
3 vessel disease
Killip IV
Age
Long term survival
050
100
1.Kw
3.Kw
Wsch.Zach.Płn.
NSTNST--ACSACS:: STEMISTEMI
__ __ SA; SA; ____ NSTEMI; NSTEMI; ____ STEMISTEMI __ __ CABG; CABG; __ __ PCI; PCI; ____ ConsCons..
StableStable anginaanginaTotalTotal
__ __ CABG; CABG; __ __ PCI; PCI; ____ ConsCons..__ __ CABG; CABG; __ __ PCI; PCI; ____ ConsCons..
Death adjustmentsLM-PCI vs. CABG
10 PCI better CABG better
Stable angina
NST-ACS
STEMI
Unadjusted
Adjusted for propensity score
Unadjusted
Adjusted for propensity score
Unadjusted
Adjusted for propensity score
OR (95% CI, p-value)2,1 (0,6-7,9; p=0,258)
2,8 (0,6-12,5; p=0,174)
0,8 (0,4-1,5; p=0,6)
0,8 (0,4-1,6; p=0,6)
2,5 (1,5-5,6; p=0,02)
2,8 (1,2-6,4; p=0,001)
Covariates: Euroscore, age, sex, KILIP IV, LVEF
CONCLUSIONSCONCLUSIONS
• Despite preliminary intention to treat LM coronary artery disease with CABG (ca 70%), only 50% of patients with SA or NST-ACS underwent surgical revascularization.
• 11% of patients with SA and 24% with NSTE-ACS underwent PCI
• Propensity score shows similar results after PCI and CABG in SA and NST-ACS, and better resultsin STEMI
• Further statisical analysis will need to be applied to compare efficacy of different treatmentstrategies in different cohort of patients