Related Experiment Videos
Initial and long-term results of angioplasty in unprotected left main coronary artery
1Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan.
Insights
Elective unprotected left main coronary artery (LMCA) angioplasty is feasible and effective, showing better outcomes than acute or emergency procedures. Scheduled follow-up improves patient survival rates after LMCA interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Unprotected left main coronary artery (LMCA) angioplasty remains controversial despite advancements in devices.
- Existing single-center studies offer limited insights into the feasibility and effectiveness of LMCA interventions.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of unprotected left main coronary artery (LMCA) angioplasty.
- To analyze outcomes based on procedural urgency (acute, emergency, elective).
Main Methods:
- Retrospective analysis of 175 unprotected LMCA angioplasty procedures in 107 patients.
- Subgroup analysis based on acute myocardial infarction, emergency, and elective indications.
- Assessment of in-hospital mortality, angiographic restenosis, and long-term survival rates.
Main Results:
- In-hospital mortality was significantly higher in acute (35.7%) and emergency (40.0%) groups compared to the elective group (3.6%).
- Restenosis rates varied, with the acute group showing 70% and elective group 40%.
- Estimated 5-year survival rates were 50% (acute), 48.2% (emergency), and 77.5% (elective), with elective procedures demonstrating superior survival.
Conclusions:
- Elective unprotected LMCA angioplasty is relatively feasible and effective when performed with scheduled angiographic follow-up.
- Urgent LMCA angioplasty (acute/emergency) is associated with significantly higher mortality and poorer long-term survival.
- The study highlights the importance of procedural timing and follow-up in optimizing outcomes for LMCA interventions.
Abstract:
Angioplasty of the unprotected left main coronary artery (LMCA) has been controversial. Although recent single-center studies suggest that new devices may change the situation, many questions and problems remain. Therefore, the results of unprotected left main coronary angioplasty of 175 procedures in 107 patients were analyzed to evaluate its feasibility and effectiveness. The treatment of the initial 107 cases included balloon angioplasty (39 cases, 36%), directional coronary atherectomy (53 cases, 50%), and stents (15 cases, 14%). They were divided into 3 major subgroups: (1) acute group (n = 14), in which LMCA angioplasty was performed in patients with acute myocardial infarction; (2) emergency group (n = 10); and (3) elective group (n = 83). In-hospital mortality was higher in the acute (35.7%) and emergency (40.0%) groups than in the elective group (3.6%; p <0.0001). Angiographic follow-up was routinely performed and the restenosis rate including in-hospital restenosis was 70% in the acute group, 37.5% in the emergency group, and 40% in the elective group (p = NS). The mean clinical follow-up period was 2.9 years, and the estimated 5-year survival rates of the acute and emergency groups were 50% and 48.2%, respectively. However the 5-year survival rate of the elective group was higher than that seen in the acute or emergency group (77.5%; p <0.05). Repeat LMCA angioplasty was performed in 37 of 68 patients with 8.8% mortality (38.5% of acute and emergency cases and 1.8% of elective cases). The results indicated that elective unprotected LMCA angioplasty is relatively feasible and effective under scheduled angiographic follow-up.