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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
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Published on: April 24, 2017

Outcome in high risk patients with unprotected left main coronary artery stenosis treated with percutaneous coronary

Lisette Okkels Jensen1, Anne Kaltoft, Per Thayssen

  • 1Department of Cardiology, Odense University Hospital, Odense, Denmark. okkels@dadlnet.dk

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 12, 2009
PubMed

Insights

High-risk patients undergoing unprotected left main percutaneous coronary intervention (PCI) showed high mortality with ST-segment elevation myocardial infarction (STEMI). However, outcomes for non-STEMI and stable angina patients were comparable to other high-risk groups.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) lesions offers an alternative to coronary artery bypass grafting (CABG) in high-risk surgical candidates.
  • Unprotected LMCA PCI involves treating significant blockages in the main artery supplying the heart without bypass graft.
  • Assessing outcomes in high-risk populations is crucial for treatment selection.

Purpose of the Study:

  • To evaluate mortality, myocardial infarction (MI), and target lesion revascularization (TLR) rates after unprotected LMCA PCI.
  • To compare outcomes across different patient risk strata, including STEMI, NSTEMI/unstable angina, and stable angina.
  • To determine the safety and efficacy of LMCA PCI in a real-world, high-risk patient cohort.

Main Methods:

  • A retrospective analysis of 344 patients undergoing unprotected LMCA PCI with stent implantation was conducted.
  • Data were collected from the Western Denmark Heart Registry between January 2005 and May 2007.
  • Patients were stratified by indication: STEMI, NSTEMI/unstable angina, or stable angina, and followed for 18 months.

Main Results:

  • Mortality rates at 18 months were significantly higher in STEMI patients (38.0%) compared to NSTEMI/unstable angina (18.5%) and stable angina (11.2%) groups (P < 0.001).
  • MI rates were similar across groups (9.9%, 6.4%, 6.0%; P = ns), and TLR rates were low (5.6%, 4.5%, 6.9%; P = ns).
  • Five cases of stent thrombosis (4 subacute, 1 late) were observed.

Conclusions:

  • Unprotected LMCA PCI in STEMI patients is associated with a high mortality risk.
  • Long-term outcomes for NSTEMI and stable angina patients undergoing unprotected LMCA PCI are comparable to other high-surgical-risk individuals.
  • The study demonstrated low rates of target lesion revascularization and stent thrombosis, suggesting PCI is a viable option in selected high-risk patients.
Abstract

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