Long-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery disease

• Published in: International journal of cardiology Vol. 130; no. 2; pp. 185 - 189
• Main Authors: Schrale, Ryan G, van Gaal, W, Channon, K.M, Forfar, J.C, Ormerod, O.J, Banning, A.P
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 12.11.2008; Elsevier
• Subjects: Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary - mortality; Angioplasty, Balloon, Coronary - trends; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronary heart disease; Coronary Vessels - pathology; Diseases of the cardiovascular system; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Percutaneous intervention; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Time; Treatment Outcome; Unprotected left main coronary artery; Percutaneous intervention; Unprotected left main coronary artery; Prognosis; Angioplasty; Coronary artery; Instrumentation therapy; Cardiovascular disease; Left coronary artery; Coronary heart disease; Long term; Percutaneous route; Evolution; Cardiology
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2007.08.039

Abstract Background This study evaluates the in-hospital, 30 day and long-term results of stenting for unprotected left main coronary artery disease in our institution. Methods Between April 2001 and October 2005 all unprotected left main cases were retrospectively reviewed. Outcomes were obtained by case note review and postal questionnaire; primary care physicians were contacted to complete missing data. Results We identified 100 consecutive patients who underwent unprotected left main procedures, 1.44% of the institution PCI volume. Indications for a percutaneous strategy were non-surgical candidates (47), emergency revascularisation (25) and patient/physician preference (28). Overall procedural success was 97%. The majority of cases ( n = 78) were performed with a single-stent strategy. 55% received a drug-eluting stent. There were 7 in-hospital deaths, 5 in the emergency group (cardiogenic shock) and 2 non-CABG candidates. Post hospital discharge long-term clinical follow-up was 651 ± 431 days (range 6–1741). There were 8 deaths post discharge. Patients presenting as an emergency had a 72% survival rate at long-term follow-up, non-surgical candidates 83%, and patient/physician preference group had a 100% long-term survival. Multivariate analysis revealed cardiogenic shock (HR = 7.9, 95% CI 1.7–3.6, p = 0.008), failed thrombolysis (HR = 8.5, 95% CI 1.7–41.7, p = 0.008) and use of a bare-metal stent (HR = 4.4, 1.1–17.0, p = 0.034) were independent predictors of mortality. Conclusions Our data suggest that in contemporary practice stenting for unprotected left main disease can be considered as an alternative treatment to surgery for selected patients. The results of randomised controlled trials are awaited.