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Angioplasty of unprotected left main coronary stenosis: Real world experience of a single-operator group from eastern
Shuvanan Ray1, Alok Mazumder2, Soumitra Kumar3
1Chief of Cardiac Intervention, Fortis Hospital, Anandapur, Kolkata, India.
Insights
Percutaneous coronary intervention with drug-eluting stents (DES) is a feasible treatment for unprotected left main coronary artery stenosis (ULMCA) in select patients unfit for bypass surgery. This approach demonstrated a low rate of major adverse cardiovascular events in carefully chosen individuals.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- Coronary artery bypass graft surgery is standard for unprotected left main coronary stenosis (ULMCA).
- Many patients are unsuitable for CABG or prefer angioplasty.
- Percutaneous coronary intervention (PCI) offers an alternative for these patients.
Purpose of the Study:
- To evaluate the feasibility and outcomes of PCI with DES in patients with ULMCA.
- To identify predictors of major adverse cardiovascular events (MACE) after ULMCA PCI.
Main Methods:
- 86 patients with ULMCA unfit/unwilling for CABG underwent PCI with DES.
- Prospective follow-up for a median of 34.6 months for MACE.
- Angiographic follow-up at 1 year or earlier if indicated.
Main Results:
- No in-hospital death, MI, or stent thrombosis.
- Overall MACE occurred in 10.5% of patients.
- Higher MACE rates were observed in patients with distal left main disease and LVEF ≤45% (50% vs 6.38%), high SYNTAX score (36.36% vs 6.82%), and diabetes (17.95% vs 0%).
Conclusions:
- PCI with DES is feasible in selected ULMCA patients with low-intermediate SYNTAX scores, without diabetes, and normal LV function.
- Patient selection is crucial for successful ULMCA PCI outcomes.
Background:
Coronary artery bypass graft surgery is the standard treatment of unprotected left main coronary stenosis (ULMCA). However, in the real world scenario, many of these patients are unfit for CABG or prefer angioplasty as an alternative when offered the choice.
Methods:
A total of 86 clinically stable patients with ULMCA stenosis who were unfit or unwilling for CABG underwent PCI with DES at two tertiary care centers in Kolkata. Patients were followed up prospectively for a median of 34.6 months for major adverse cardiovascular events. Angiographic follow-up was done after 1 year of index procedure or earlier, if indicated.
Results:
Fifty-five patients (64%) had distal left main stenosis. Two-stent technique was used in 19 patients (22%) and single-stent technique in 36 patients (42%) with distal left main lesion. Thirteen patients (15.1%) had left ventricular ejection fraction (LVEF) of ≤45%. There was no in-hospital death, MI, or stent thrombosis. During follow-up, major adverse cardiac event (MACE) occurred in 9 patients (10.5%). Our study revealed significantly greater MACE in patients with distal left main lesion with LVEF ≤45% (50% vs 6.38%, p=0.0002), high SYNTAX score (36.36% vs 6.82%, p=0.008), and diabetes (17.95% vs 0.00%, p=0.07). Overall, also patients with Diabetes, LVEF ≤ 45%, and SYNTAX score >32 had significantly higher MACE. Use of IC Stent, IVUS, or procedural strategy in distal lesion did not affect MACE.
Conclusion:
In selective patients with low-intermediate SYNTAX score and without diabetes and LV dysfunction, ULMCA PCI with DES is feasible.