title: Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients.
abstract: BACKGROUND
  Percutaneous coronary revascularization (PCI) has been increasingly applied to unprotected left main trunk (LMT) lesions, with varied long-term success. This study attempts to define the predictors of outcome in this population.
  
  
  RESULTS
  Two hundred seventy-nine consecutive patients who had LMT PCI at 1 of 25 sites between 1993 and 1998 were studied. Forty-six percent of these patients were deemed inoperable or at high surgical risk. Thirty-eight patients (13.7%) died in hospital, and the rest were followed up for a mean of 19 months. The 1-year incidence was 24.2% for all-cause mortality, 20.2% for cardiac mortality, 9.8% for myocardial infarction, and 9.4% for CABG. Independent correlates of all-cause mortality were left ventricular ejection fraction </=30%, mitral regurgitation grade 3 or 4, presentation with myocardial infarction and shock, creatinine >/=2.0 mg/dL, and severe lesion calcification. For the 32% of patients <65 years old with left ventricular ejection fraction >30% and without shock, the prevalence of these adverse risk factors was low. No periprocedural deaths were observed in this low-risk subset, and the 1-year mortality was only 3.4%.
  
  
  CONCLUSIONS
  Patients undergoing unprotected LMT PCI have frequent serious comorbidities and consequently have high event rates. PCI may be an alternative to CABG for a select proportion of elective patients and may also be appropriate for highly symptomatic inoperable patients. Meticulous follow-up of hospital survivors is required because of the rather high mortality during the first few months after treatment.
authors.affiliation: Pittsburgh Vascular Institute, UPMC Shadyside, Pittsburgh, PA, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Tan
authors.forename: H
authors.initials: H
authors.lastname: Tamai
authors.forename: S J
authors.initials: SJ
authors.lastname: Park
authors.forename: H W
authors.initials: HW
authors.lastname: Plokker
authors.forename: M
authors.initials: M
authors.lastname: Nobuyoshi
authors.forename: T
authors.initials: T
authors.lastname: Suzuki
authors.forename: A
authors.initials: A
authors.lastname: Colombo
authors.forename: C
authors.initials: C
authors.lastname: Macaya
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: D J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: P L
authors.initials: PL
authors.lastname: Whitlow
authors.forename: S G
authors.initials: SG
authors.lastname: Ellis
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015331:Cohort Studies; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome