Long-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery disease
Ryan G Schrale1, W van Gaal, K M Channon
1Department of Cardiology, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom. rschrale@hotmail.com
Insights
Percutaneous coronary intervention (PCI) stenting for unprotected left main disease shows promising in-hospital and long-term survival rates, especially for selected patients. Further randomized trials are needed to confirm these findings.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Coronary Artery Disease Management
Background:
- Unprotected left main coronary artery disease poses significant risks.
- Stenting is an alternative revascularization strategy to coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate the in-hospital, 30-day, and long-term outcomes of stenting for unprotected left main coronary artery disease.
- To identify predictors of mortality in patients undergoing this procedure.
Main Methods:
- Retrospective review of 100 consecutive unprotected left main stenting cases (April 2001-October 2005).
- Data collection via case notes, postal questionnaires, and primary care physician contact.
- Long-term follow-up averaged 651 days.
Main Results:
- 97% procedural success rate.
- 7 in-hospital deaths (5 in emergency group).
- Long-term survival varied by indication: 72% (emergency), 83% (non-surgical), 100% (preference). Cardiogenic shock, failed thrombolysis, and bare-metal stents predicted mortality.
Conclusions:
- Stenting for unprotected left main disease is a viable alternative to surgery for selected patients.
- Outcomes are influenced by patient selection and stent type.
- Randomized controlled trials are needed to further validate these findings.
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.
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