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