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CLINICAL STUDIES

Unprotected left main coronary artery stenting: immediate and medium- term outcomes of 140 elective procedures

^a Cardiology Department, Beauregard Private Hospital Center, Marseille, France

Manuscript received May 11, 1999; revised manuscript received November 22, 1999, accepted January 12, 2000.

Reprint requests and correspondence: Dr. Marc Silvestri, Service de Cardiologie, Centre Hospitalier Privé Beauregard, 12 impasse du Lido, 13012 Marseille, France
msilvestri_cuecv{at}hotmail.com

OBJECTIVES

We sought to evaluate immediate and late outcomes after stenting for left main coronary artery (LMCA) stenosis.

BACKGROUND

Conventional percutaneous transluminal coronary angioplasty (PTCA), for which coronary artery bypass grafting (CABG) has been the gold standard therapy for years, has yielded poor results in unprotected LMCA lesions. The development of coronary stents, together with their dramatic patency improvement provided by new antiplatelet regimens and their validation against restenosis, warrants a reappraisal of angioplasty in LMCA stenosis.

METHODS

From January 1993 to September 1998, 140 consecutive unselected patients with unprotected LMCA stenosis underwent elective stenting. Group I included 47 high-CABG-risk patients, and group II included 93 low-CABG-risk patients. Ticlopidine without aspirin was routinely started at least 72 h before the procedure and continued for one month. Patients were reevaluated monthly. A follow-up angiography was requested after six months.

RESULTS

The procedure success rate was 100%. One-month mortality was 9% (4/47) in group I and 0% in group II. A follow-up angiography was obtained in 82% of cases, and target lesion revascularization was required in 17.4%. One-year actuarial survival was 89% in the first 29 group I patients and 97.5% in the first 63 group II patients.

CONCLUSIONS

Stenting of unprotected LMCA stenosis provided excellent immediate results, particularly in good CABG candidates. Medium-term results were good, with a restenosis rate of 23%, similar to that seen after stenting at other coronary sites. Stenting deserves to be considered a safe and effective alternative to CABG in institutions performing large numbers of PTCAs.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CASS = Coronary Artery Surgery Study   IVUS = intravascular ultrasound   LAD = left anterior descending   LMCA = left main coronary artery   LVEF = left ventricular ejection fraction   MI = myocardial infarction   MLD = minimal lumen diameter   PTCA = percutaneous transluminal coronary angioplasty

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