Long-term mortality in patients unsuitable for surgical revascularization undergoing elective left main coronary
L Vignali1, G Talanas, A Menozzi
1Division of Cardiology, University Hospital of Parma, Parma, Italy. luvignali@ao.pr.it
Insights
Percutaneous coronary intervention (PCI) for left main coronary artery disease is safe and feasible for high-risk patients unsuitable for bypass surgery. Long-term mortality rates are acceptable, with no significant difference between protected and unprotected left main interventions.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Devices
Background:
- Left main coronary artery disease poses significant challenges in interventional cardiology.
- Percutaneous coronary intervention (PCI) offers an alternative revascularization strategy for patients unsuitable for coronary artery bypass graft (CABG).
Purpose of the Study:
- To evaluate the safety and long-term mortality of PCI in patients with left main coronary artery disease.
- To analyze long-term mortality based on patient demographics and stent types (drug-eluting stents [DES] vs. bare metal stents [BMS]).
Main Methods:
- Retrospective review of 131 patients undergoing PCI for left main stem disease between January 2003 and December 2006.
- Kaplan-Meier survival analysis and Log-rank testing were used to compare mortality rates.
- Mean follow-up duration was 14.0 ± 10.8 months.
Main Results:
- No statistically significant difference in all-cause mortality was observed between protected and unprotected left main PCI (12% vs. 14%, P=0.67).
- Drug-eluting stents (DES) were used significantly more often in the protected left main group (59% vs. 43%, P=0.02).
Conclusions:
- PCI for left main coronary disease is a feasible and safe procedure.
- It offers an acceptable long-term mortality rate for high-surgical risk patients who are not candidates for CABG.
Aim:
Elective percutaneous coronary intervention (PCI) of left main coronary artery disease remains an important challenge in interventional cardiology. Nonetheless, this procedure is useful for patients with significant left main stenosis who are candidates for revascularization but unsuitable for coronary artery bypass graft. In this study the Authors sought to evaluate the safety and long-term mortality of PCI of left main coronary artery disease. Secondary endpoints were to analyse long-term mortality in various categories (patients<75 years vs patients<75 years, males vs females, drug eluting stents [DES] vs bare metal stents [BMS]).
Methods:
Between January 2003 and December 2006, 131 patients who consecutively under-went PCI on left main stem were reviewed. The mean follow-up time was 14.0+/-10.8 months. Survival curves were plotted with the Kaplan-Meier method and compared with the Log-rank test.
Results:
The Kaplan-Meier curves did not show statistically significant differences in terms of all-cause mortality at follow-up between protected and unprotected left main coronary disease (12% vs 14% respectively, P=0.67). In the protected left main group, there was a significantly higher use of DES compared with unprotected left main group (59% vs 43%, P=0.02).
Conclusion:
The data show that PCI for left main coronary disease is feasible, safe and with an acceptable long-term mortality rate in patients at high-surgical risk unsuitable for surgical revascularization.