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Impact of stents on clinical outcomes in percutaneous left main coronary artery revascularization
R Kornowski1, M Klutstein, L F Satler
1Catheterization Laboratory and the Cardiology Research Foundation, Washington Hospital Center, Washington, DC, USA.
Insights
Left main coronary artery (LMCA) stenting reduced hospital complications compared to non-stent procedures. However, LMCA stenting did not significantly lower repeat revascularization or major cardiac events at one year.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Left main coronary artery (LMCA) disease requires effective treatment, often after initial coronary bypass surgery.
- Progression of LMCA disease or bypass graft failure necessitates further interventions.
Purpose of the Study:
- To compare in-hospital and 1-year outcomes of LMCA interventions using stents versus non-stent procedures.
- To evaluate the safety and efficacy of LMCA stenting in patients with prior coronary bypass.
Main Methods:
- Retrospective comparison of LMCA stenting (n=88) versus non-stent procedures (n=36).
- Matched patient groups, with 97% having prior coronary bypass.
- Assessment of procedural success, complications, myocardial infarction, death, target lesion revascularization, and cardiac event-free survival at 1 year.
Main Results:
- Procedural success was higher in the stent group (98% vs 92%), with fewer overall complications (0% vs 5.4%).
- Non-Q-wave myocardial infarction was more frequent in the stent group (13% vs 2.7%).
- No significant differences in death, Q-wave myocardial infarction, target lesion revascularization (15% vs 18%), or 1-year cardiac event-free survival (78% vs 76%) between groups.
Conclusions:
- LMCA stenting reduces major in-hospital complications compared to non-stent procedures.
- Stenting did not significantly decrease repeat revascularization or major cardiac events at one year.
- LMCA stenting is a viable option for managing LMCA disease, particularly in patients with prior bypass, balancing procedural safety with long-term outcomes.
Abstract:
Despite effective treatment of left main coronary artery (LMCA) disease by coronary bypass, there is still need for treatment of the LMCA due to progression of disease or bypass graft failure. We compared the in-hospital and follow-up (1-year) outcomes of patients with LMCA stenosis treated with stents (n = 88), with a matched group of patients undergoing LMCA non-stent procedures (n = 36). Ninety-seven percent of patients in each group underwent previous coronary bypass. Procedural success (angiographic success without major in-hospital complications) tended to be higher in stent patients than in their non-stent counterparts (98% vs 92%, p = 0.12), and overall procedural complications were higher for the non-stent group (5.4% vs 0%, p = 0.03). The incidence of non-Q-wave myocardial infarction was higher in patients with the LMCA treated with stents than in non-stent patients (13% vs 2.7%, p = 0.09). There was no difference in death or Q-wave myocardial infarction between the 2 groups during follow-up. Overall target lesion revascularization at 1 year was 15% after LMCA stenting, and 18% in non-stent patients (p = 0.71). Also, any cardiac event-free survival (including death, Q-wave myocardial infarction, coronary bypass, or angioplasty) was similar for both groups (78% for stents vs 76% for non-stents, p = 0.85). We conclude that in patients undergoing LMCA interventions, stents reduce major hospital complications, but may not significantly reduce repeat revascularization or major cardiac events at 1 year compared with non-stent LMCA procedures.