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Published on: May 28, 2019
[Immediate and long-term outcome after angioplasty with stenting of the left main coronary artery]
Vicens Martí1, Francesc Planas, Carlos Cotes
1Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 18461vmc@comb.es
Insights
Elective angioplasty with stenting for severe left main coronary artery stenosis shows high success and low event rates. Emergency procedures and left ventricular dysfunction predict in-hospital mortality in these patients.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Vascular Medicine
Background:
- Severe left main coronary artery stenosis traditionally treated with coronary artery bypass graft surgery.
- Percutaneous coronary intervention with stenting is emerging as a potential alternative.
- Assessing the safety and efficacy of angioplasty for left main stenosis is crucial.
Purpose of the Study:
- To evaluate immediate and long-term outcomes of angioplasty with stenting for left main coronary artery stenosis.
- To identify predictors of mortality in patients undergoing this procedure.
- To compare outcomes between elective and emergency interventions.
Main Methods:
- Retrospective analysis of 38 patients with severe left main coronary artery stenosis treated with angioplasty and stenting (1997-2003).
- Procedures were elective (n=27) or urgent (n=11).
- Clinical follow-up averaged 25 months, assessing mortality and major adverse cardiac events.
Main Results:
- High angiographic success rate (100%).
- In-hospital mortality was 15.8%, significantly higher in the emergency group (45.4%) vs. elective (3.7%) (P=.007).
- All deaths occurred in patients with unprotected left main coronary arteries; emergency intervention and left ventricular dysfunction predicted mortality.
Conclusions:
- Elective angioplasty and stenting in selected patients with left main coronary artery stenosis yields high immediate success.
- Long-term outcomes for elective procedures are favorable with a low incidence of major cardiac events.
- Emergency angioplasty and signs of left ventricular dysfunction are key predictors of in-hospital mortality.
Introduction And Objectives:
Coronary artery bypass graft surgery is the treatment of choice for severe left main coronary artery stenosis. The results of a number of multicenter trials have suggested angioplasty with stenting as a possible alternative treatment. The aim of the present study was to analyze the immediate and long-term results of angioplasty with stenting of the left main coronary artery, and to identify factors predictive of death.
Patients And Method:
A total of 38 nonconsecutive patients (mean age 69 [8] years) with a severe lesion in the left main coronary artery were treated with angioplasty and stenting between November 1997 and March 2003. The procedure was elective in 27 patients and urgent in the remaining 11. In 23 patients (60.5%) the left main coronary artery was not protected by aortocoronary bypass. All patients underwent clinical follow-up examination at 25 (20) months.
Results:
Angiographically documented success was obtained in all patients. However, one patient died from acute occlusion one hour after the operation. Four patients (10%) had a non-Q-wave myocardial infarction. In-hospital mortality was 15.8% (6/38 patients). Five of the 11 patients (45.4%) who underwent emergency angioplasty and stenting died in the hospital from acute myocardial infarction complicated by severe (Killip grade III-IV) heart failure. However, only one of 27 patients (3.7%) in the elective surgery group died (P=.007). Major clinical cardiac events during follow-up occurred in 5 patients (13%); 3 died and the other 2 had recurrent angina. All patients who died had an unprotected left main coronary artery. Cumulative survival rates for the elective group were 92 (0.5)% at 6 months, 88 (0.6)% at 1 year and 86 (0.7)% at 3 years, respectively. For the emergency surgery group cumulative survival rate was 54 (0.2)% at 6 months (P<.05).
Conclusions:
Elective angioplasty and stenting of the left main coronary artery in selected patients was associated with a high immediate success rate. In patients who underwent elective angioplasty and stenting, the incidence of major cardiac events during follow-up was relatively low. Emergency angioplasty and signs of left ventricular dysfunction were the main predictors of in-hospital mortality.
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