CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY
Unprotected left main coronary artery stenting
Correlates of midterm survival and impact of patient selection
Alexander Black, Jr, MBBS*,
Rosario Cortina, MD ,
Irene Bossi, MD,
R.émi Choussat, MD,
Jean Fajadet, MD* and
Jean Marco, MD
* Department of Cardiology, The Geelong Hospital, Geelong, Victoria, Australia
Unité de Cardiologie Interventionelle, Clinique Pasteur, Toulouse, France
Manuscript received December 6, 1999;
revised manuscript received September 22, 2000,
accepted November 3, 2000.
Reprint requests and correspondence: Dr. J. Fajadet, Unité de Cardiologie Interventionelle, Clinique Pasteur, 45, avenue de Lombez, 31076 Toulouse, France
fajadet{at}interv-cardio-toul.com
OBJECTIVES
The study served to present the in-hospital and six-month clinical outcome and also the long-term survival data of a consecutive series of patients undergoing stenting for unprotected left main coronary artery (LMCA) disease.
BACKGROUND
Revascularization with coronary bypass surgery has been generally recommended for treatment of left main coronary stenosis. Improvements in angioplasty and coronary stent techniques and equipment may result in the wider applicability of a percutaneous approach.
METHODS
A total of 92 consecutive patients underwent unprotected LMCA stenting between March 1994 and December 1998. For the initial 39 patients (group I) angioplasty was performed only when surgical revascularization was contraindicated. The remaining 53 patients (group II) also included patients in whom surgery was feasible. Patients were followed for 7.3 ± 5.8 months (median 239 days; range 49 to 1,477 days).
RESULTS
Compared to group I, group II patients had higher left ventricular ejection fraction (60 ± 12% vs. 51 ± 16%, p < 0.01), less severe LMCA stenosis (68 ± 12% vs. 80 ± 10%, p < 0.001), lower surgical risk score (13 ± 7 vs. 20 ± 7, p < 0.001), and had angioplasty more often performed via the radial approach (88% vs. 23%, p < 0.001) with smaller guiding catheters (6F: 49% vs. 15%; 8F: 2% vs. 77%, p < 0.001). The procedural success rate was 100%. In-hospital mortality was 4% (4 deaths, 3 cardiac). During follow-up there were six deaths, 13 patients required repeat percutaneous transluminal coronary angioplasty (4 LMCA), and two required coronary artery bypass graft surgery. Estimated survival (±SEE) was 89 ± 6.3% at 500 days and 85 ± 12% at 1,000 days post-stenting. Overall mortality was 3.8% in group II and 20.5% in group I (p < 0.02).
CONCLUSIONS
Coronary stenting can be performed safely in high-risk individuals with acceptable intermediate-term outcome. It may be feasible to broaden the application of this technique in selected patients needing revascularization for left main coronary disease.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft | | CHF | = congestive heart failure | | LMCA | = left main coronary artery | | LVEF | = left ventricular ejection fraction | | MI | = myocardial infarction | | MLD | = minimum lumen diameter | | PTCA | = percutaneous transluminal coronary angioplasty | | RCA | = right coronary artery |
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