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[Percutaneous intervention in left main coronary disease: medium and long term clinical outcomes in a high risk

Marta Ponte1, Ricardo Fontes-Carvalho, Rita Faria

  • 1Serviços de Cardiologia e de Cirurgia Cardio-Torácica do Centro Hospitalar de Vila Nova de Gaia/Espinho e Faculdade de Medicina da Universidade do Porto. Portugal.

Revista Portuguesa De Cirurgia Cardio-Toracica E Vascular : Orgao Oficial Da Sociedade Portuguesa De Cirurgia Cardio-Toracica E Vascular
|April 24, 2013
PubMed

Insights

Percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease is safe for selected patients. However, outcomes are poor for those undergoing emergent PCI or refused for surgery due to high baseline risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Coronary artery bypass graft (CABG) is the standard for left main coronary artery (LMCA) disease.
  • Percutaneous coronary intervention (PCI) is increasingly used for LMCA disease.
  • Assessing LMCA PCI outcomes in a cardiac surgery hospital is crucial.

Purpose of the Study:

  • To evaluate mid- and long-term clinical outcomes of LMCA PCI.
  • To compare outcomes across different indications for LMCA PCI.

Main Methods:

  • Retrospective analysis of 96 patients undergoing LMCA PCI (2005-2011).
  • Patients grouped by indication: refused surgery (G1), emergent PCI (G2), protected LMCA (G3), favorable anatomy (G4).
  • Follow-up in 100% of patients (median 21 months).

Main Results:

  • Overall mortality was 28.1% (14.6% cardiovascular).
  • Major adverse cardiovascular and cerebrovascular event (MACCE) rate was 26%.
  • Mortality was significantly higher in G1 and G2 (46.4%, 64.3%) vs. G3 and G4 (11.1%, 5.6%).

Conclusions:

  • LMCA PCI is safe with low mortality in patients with protected LMCA or favorable anatomy.
  • Emergent PCI or PCI in patients refused surgery carries a high event rate due to baseline risk.
  • PCI is a viable option for specific LMCA disease patient groups.
Abstract

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