Unprotected left main coronary artery stenting: correlates of midterm survival and impact of patient selection

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Published on: May 14, 2013

A Black1, R Cortina, I Bossi

  • 1Department of Cardiology, The Geelong Hospital, Victoria, Australia.

Journal of the American College of Cardiology
|November 6, 2001
PubMed

Insights

Coronary stenting for unprotected left main coronary artery disease is safe and effective, offering acceptable intermediate-term outcomes. This percutaneous approach may be suitable for selected high-risk patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Coronary bypass surgery is the standard for left main coronary artery (LMCA) disease.
  • Percutaneous coronary intervention (PCI) using stenting is an evolving alternative.
  • This study evaluates stenting outcomes for unprotected LMCA disease.

Purpose of the Study:

  • To assess the in-hospital and six-month clinical outcomes of unprotected LMCA stenting.
  • To present long-term survival data for patients undergoing this procedure.
  • To explore the feasibility of expanding PCI for LMCA disease.

Main Methods:

  • A consecutive series of 92 patients with unprotected LMCA disease underwent stenting (March 1994-December 1998).
  • Patients were divided into two groups: Group I (39 patients) with contraindications to surgery, and Group II (53 patients) including those with feasible surgical options.
  • Follow-up averaged 7.3 months.

Main Results:

  • Procedural success rate was 100%. In-hospital mortality was 4%.
  • Group II patients had better ejection fraction, less severe stenosis, lower surgical risk, and higher radial approach use.
  • Estimated survival was 89% at 500 days and 85% at 1,000 days. Overall mortality was significantly lower in Group II (3.8%) vs. Group I (20.5%).

Conclusions:

  • Coronary stenting is a safe option for high-risk patients with unprotected LMCA disease.
  • The technique offers acceptable intermediate-term results.
  • PCI may be considered for selected patients requiring revascularization for LMCA disease.
Abstract

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