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Left Coronary Artery Ligation: A Surgical Murine Model of Myocardial Infarction
Published on: August 9, 2022
Long-term outcome of percutaneous coronary intervention for unprotected left main coronary artery disease
Xue-Ming Wu1, Chung-Pin Liu, Wei-Cheng Lin
1Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Percutaneous coronary intervention (PCI) with drug-eluting stents is a viable treatment for unprotected left main coronary artery disease, showing acceptable outcomes. However, bifurcation involvement is a predictor of major adverse cardiac events.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Devices
Background:
- Left main coronary artery (LMCA) stenosis traditionally requires coronary artery bypass grafting (CABG).
- Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is emerging as an alternative for unprotected LMCA disease.
- Patient selection for PCI in LMCA disease often involves prohibitive surgical risk or patient preference.
Purpose of the Study:
- To evaluate in-hospital, 30-day, and long-term outcomes of PCI for unprotected LMCA disease.
- To assess the safety and efficacy of PCI with DES in this patient population.
- To identify predictors of adverse events after PCI for unprotected LMCA disease.
Main Methods:
- Retrospective analysis of 55 consecutive patients undergoing unprotected LMCA PCI between January 2003 and February 2007.
- Data collected via chart review and telephone interviews.
- Outcomes assessed included procedural success, in-hospital events, and long-term major adverse cardiac events (MACE).
Main Results:
- Procedural success rate was 98% with 75% of patients receiving DES.
- No in-hospital deaths occurred.
- Long-term follow-up (mean 867 days) revealed MACE in 29% of patients, including death (5%), myocardial infarction (7%), and target lesion revascularization (21.8%). Hyperlipidemia and bifurcation involvement were independent predictors of MACE.
Conclusions:
- PCI with stenting is an acceptable treatment for LMCA stenosis, particularly in high-risk surgical candidates.
- LMCA bifurcation involvement is a significant predictor of unfavorable outcomes.
- Further research may optimize PCI strategies for complex LMCA lesions.
Objectives:
The aim of this study is to evaluate the in-hospital, 30 day and long-term outcomes after percutaneous coronary intervention for unprotected left main coronary artery disease.
Backgrounds:
Left main coronary artery (LMCA) diseases stenosis is a strong indication for coronary artery bypass grafting (CABG). With improved device technology, percutaneous coronary intervention (PCI) with drug-eluting stent (DES) stents had been recently advocated as an alternative procedure for the unprotected LMCA disease.
Methods:
Between January 2003 and February 2007, all unprotected LMCA PCI procedures were retrospectively collected. Outcomes were obtained by chart record review and telephone interview.
Results:
Fifty five consecutive patients with >50% diameter stenosis of LMCA undergoing PCI were analyzed. Indications for a percutaneous strategy were prohibitive surgical risks, or patient/physician preference. The procedural success rate was 98%. 41 patients (75%) received DES implantation. The majority of cases (n=33) were treated with a double-stent strategy. There were no in-hospital deaths. The clinical follow-up time was 867+/-410 days (range 20-1715). 18 (29%) patients experienced major adverse cardiac events, including 3 (5%) deaths, 4 (7%) myocardial infarctions, and 12 (21.8%) target lesion revascularizations (TLR) during follow-up. Multivariate analysis revealed hyperlipidemia (Hazard ratio, HR=6.2, p=0.024) and bifurcation involvement (HR=4.4, p=0.008) were independent predictors for MACE.
Conclusions:
Our results showed that PCI with stenting was an acceptable treatment option for patients with LMCA stenosis. Involvement of the LMCA bifurcation remains a predictor for unfavorable outcome.
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