Percutaneous coronary artery intervention in unprotected left main coronary artery disease: one-year outcome Egyptian
Rana Ayman1, Sameh Mohamed Shaheen2, Sameh Saleh Sabet2
1Cardiology Department, Ain Shams University Hospital, Nargess 3 - Fifth Settlement, Abbassya, PO 11835, Cairo, Egypt. ranaayman54@gmail.com.
Insights
Percutaneous coronary intervention for left main coronary artery disease is safe and effective. Provisional stenting is preferred over the two-stent technique for better outcomes, with adjunctive imaging aiding results.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Left main coronary artery (LMCA) lesions pose significant risks due to large myocardial territory jeopardy, leading to high morbidity and mortality.
- Optimal revascularization strategies for LMCA bifurcation lesions, particularly using percutaneous coronary intervention (PCI), remain a subject of debate.
- Unprotected LMCA disease requires careful consideration for treatment, with PCI offering a less invasive alternative to surgery.
Purpose of the Study:
- To evaluate the one-year clinical outcomes of unprotected LMCA disease treated with PCI.
- To compare the effectiveness of provisional stenting versus the two-stent technique in a real-world Egyptian patient cohort.
- To assess safety and efficacy endpoints, including major adverse cardiovascular and cerebrovascular events (MACCE) and target vessel failure (TVF).
Main Methods:
- A prospective, observational, single-center study involving 163 patients undergoing PCI for unprotected LMCA lesions.
- Patients were categorized into two groups based on the intended stenting technique: provisional (142 patients) or two-stent (21 patients, primarily DK crush).
- Follow-up included in-hospital, 30-day, and 1-year assessments for clinical endpoints.
Main Results:
- In-hospital mortality was 6.34% in the provisional group, with 5.36% cardiovascular-related deaths.
- Overall MACCE at one year was 22.31% for provisional stenting versus 30% for the two-stent technique (p=0.57).
- Target vessel failure (TVF) was significantly lower in the provisional group (10%) compared to the two-stent group (30%, p=0.023).
Conclusions:
- PCI is a safe and beneficial treatment for LMCA lesions.
- Provisional stenting is the preferred strategy, with the option for bail-out procedures if the side branch requires further intervention.
- Adjunctive use of intravascular ultrasound (IVUS) or fractional flow reserve (FFR) may improve outcomes and should be facilitated.
Background:
Left main coronary artery lesions are associated with jeopardy of an outsized area of the myocardium, causing a high incidence of morbidity and mortality. Optimal treatment of coronary bifurcation anatomy remains highly debatable, whether by provisional or two-stent technique. This prospective observational study was designed to investigate the one-year clinical outcomes of unprotected left main coronary artery disease revascularization by percutaneous coronary intervention in a "real-world" setting among Egyptian patients in a prospective single-center registry (at Ain Shams University Hospitals).
Results:
This study included 163 patients who underwent PCI to LM lesions between May 1, 2020, and the end of April in Ain Shams University hospitals. Patients were dichotomized into two groups according to their intended stenting technique, whether provisional or two-stent technique. A total of 142 underwent provisional stenting while 21 were designated for the two-stent technique, mainly DK crush (double kissing). Among the patients with intended provisional stenting, 34 patients underwent the TAP technique. Patients were followed up for the primary endpoints, at the in-hospital setting, at 30 days, and after 1 year. In-hospital death was encountered in 6.34% of cases undergoing provisional stenting, among which 5.36% were due to a cardiovascular cause. Total MACCE was found to be 2.96% in the provisional stenting group versus 4.76% in the two-stent group. Overall, MACCE at 1 year was found to be 22.31% in the provisional group and 30% in the two-stent group (p-value0.57). TVF was recognized in 10% of cases treated by provisional stenting and 30% of cases treated by the two-stent technique (p-value 0.023).
Conclusions:
LM coronary artery lesions treatment by PCI is considered a safe and beneficial solution. Provisional stenting is the preferred approach bearing in mind that bail-out procedures may be sought in case the SB needs further treatment. Adjunctive assessment by IVUS or FFR may help achieve better outcomes, and efforts should be performed to facilitate their feasibility.
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