Results and Long-Term Predictors of Adverse Clinical Events After Elective Percutaneous Interventions on Unprotected Left Main Coronary Artery

With the intent to provide further data in this controversial field, we examined and report our complete experience with elective percutaneous treatment of lesions involving unprotected left main coronary artery

Takuro Takagi; Goran Stankovic; Leo Finci; Konstantinos Toutouzas; Alaide Chieffo; Vassilis Spanos; Francesco Liistro; Carlo Briguori; Nicola Corvaja; Remo Albero; Ginevra Sivieri; Rossella Paloschi; Carlo Di Mario; Antonio Colombo


Scholarcy highlights

  • The safety and efficacy of percutaneous coronary intervention of de novo lesions in unprotected left main coronary arteries remains an unresolved issue
  • The long-term follow-up revealed a high rate of angiographic restenosis and repeat revascularization, with a relatively high incidence of cardiac death
  • Procedural success was defined as revascularization in the target lesion with Յ30% residual stenosis according to angiography and with the patient leaving hospital free from any of the following events: death, Q-wave or non–Q-wave myocardial infarction, or coronary artery bypass graft
  • The site of the lesion in the left main coronary artery was the ostium in 22% of patients, the midportion of the artery in 18%, and the distal bifurcation in 60%
  • The major findings in this study are percutaneous coronary interventions with stenting of lesions located in the LM is feasible in a variety of lesions with high immediate clinical success; at an average follow-up time of 31 months there is an incidence of cardiac death of 11.9% and of a need of target vessel revascularization of 24.6%; patients with a high surgical risk by Parsonnet score have a 21.4% 3-year cardiac mortality rate compared with 4.2% in patients with a low surgical risk; and the most important predictor of major adverse cardiac events during follow-up is the reference vessel size of the LM, whereas left ventricular ejection fraction Յ0.40 is the only covariate of cardiac death
  • With regard to the value of atherectomy debulking before stenting, we cannot draw any conclusion from our study, most probably because of the small number of patients treated with this approach, the tendency of the operator to use atherectomy in the most complex bifurcations, and some limitations in the ability to perform effective debulking in both branches, especially with the old devices used in the early time of this experience
  • The first published multicenter experience in 107 patients including both elective and emergent treatment showed an in-hospital mortality rate of 12% and a cumulative 1-year mortality rate of 29%, whereas recent studies in patients with elective treatment reported very low hospital complications and a 1-year survival rate of 97% or higher. an updated report from the ULTIMA Registry continued to show a high in-hospital and follow-up mortality rates

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