Short, midterm and late results of percutaneous coronary interventions for left main coronary artery disease
Insights
Percutaneous coronary intervention (PCI) offers a safe alternative to coronary artery bypass graft for left main coronary artery disease. PCI is effective in selected patients and should be performed in experienced centers.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Left main coronary artery disease affects 4-6% of patients undergoing coronary angiography.
- Coronary artery bypass graft surgery is the traditional standard of care.
- Percutaneous coronary intervention is an evolving alternative to surgery for this condition.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous coronary intervention (PCI) for left main coronary artery disease.
- To identify predictors of major adverse cardiac events (MACE) and in-stent restenosis after PCI.
Main Methods:
- Retrospective study of 32 patients with left main coronary artery disease treated with angioplasty.
- Data collected between January 2005 and March 2011.
- Analysis of angiographic success, in-hospital outcomes, and long-term MACE and restenosis rates.
Main Results:
- High angiographic success rate (97%) and low in-hospital complication rate (94% uneventful).
- Mean follow-up of 18.5 months showed a 16.12% in-stent restenosis rate and 29% MACE rate.
- Predictors of MACE included cardiogenic shock, emergency procedures, high Euroscore/Parsonnet scores, elevated C-reactive protein, creatinine levels, and stent type.
Conclusions:
- Percutaneous coronary intervention is a safe and validated alternative to coronary artery bypass graft for left main coronary artery disease.
- PCI should be reserved for carefully selected patients.
- Procedures should be performed in experienced interventional cardiology centers.
Background:
Left main coronary artery disease is found in 4-6% of patients undergoing diagnostic coronary angiography. Coronary artery bypass graft is the gold standard. However, percutaneous coronary intervention is a continuously evolving substitution for surgery in such patients.
Methods:
We report a retrospective study of 32 patients with relevant left main coronary artery disease treated by angioplasty in our faculty, between January 2005 and March 2011.
Results:
The mean age of the population on the study was 59.7±10.9 years. The sex-ratio was 3.57. The rate of angiographic success was 97%. The in-hospital stay was uneventful in 94%¨of our patients. Only one patient died of cardiogenic shock complicating an acute anterior myocardial infarction. After a mean follow up of 18.5 ± 15.4 months, the in-stent restenosis rate was 16.12%. The rate of major adverse cardiac events (MACE) was 29%. Independent predictive factors of MACE were: cardiogenic shock on admission (p=0.022), emergency procedures (p=0.033), Euroscore > 6 (p=0.001), Parsonnet score > 20 (p=0.036), High C réactive protein levels on admission (p=0.007),le taux de créatinine (p=0.008), un diamètre de référence du TCCG < 3.5 mm (p =0.036) et l'utilisation de stents (p=0.036) and the use of bare metal stents (p=0.036). Independent predictive factors of in-stent restenosis were: use of bare metal stents (p=0.004) and Paclitaxel drug eluting stents (p=0.037).
Conclusion:
Percutaneous coronary intervention is safe and a validated alternative to coronary artery bypass graft for left main coronary artery disease. However, it should be reserved to selected patients and limited to experienced centers.
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