Angioplastie du tronc commun gauche non protégé : valeur pronostique du SYNTAX score II
Mots-clés :
Tronc commun non protégé, angioplastie, pronostic, SYNTAX score IIRésumé
Introduction : Les sténoses du tronc commun gauche (TCG) représentent des lésions complexes mettant en jeu le pronostic vital.
But : Evaluer les résultats ainsi que les facteurs pronostiques à long terme des patients traités par intervention coronarienne percutanée (ICP) du TCG non protégé.
Méthodes : Nous avons réalisé une étude prospective entre 2012 et 2017 incluant tous les patients ayant bénéficié d’une ICP du TCG non protégé.
Résultats : Entre janvier 2012 et décembre 2017, nous avons retenu 150 patients consécutifs. L’âge moyen était 64±12 ans et 85% des patients étaient de sexe masculin. Le diabète était présent dans 50.7% des cas. Une revascularisation dans contexte de sauvetage a été notée chez 20,7% des patients avec 3,3% de chocs cardiogéniques. L’atteinte distale du TCG était prédominante (76.7%). 94.0% des patients avaient un SYNTAX score I bas ou intermédiaire (≤32). Le SYNTAX score II médian était de 31.1. Les stents actifs ont été utilisés dans 78,7% des cas. Dans le contexte de sauvetage, seuls les stents nus étaient disponibles. Parmi les atteintes distales, une approche à un stent était préférée (81,7%). Au terme d’un suivi médian de 13,4 mois, le taux d’événements cardiaques majeurs était de 23,3%, avec une estimation de 37,9% à 5 ans. Les facteurs prédictifs en étaient le choc cardiogénique, l’utilisation de stent nu, l’antécédent d’ICP et le SYNTAX score II ≥30.
Conclusion : L’ICP du TCG présente des résultats encourageants à court et à long terme. Le SYNTAX score II permettrait de prévoir la survenue de MACE à long terme.
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Références
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