One-year clinical outcomes of protected and unprotected left main coronary artery stenting.
OBJECTIVE
To evaluate outcomes for left main coronary artery (LMCA) stenting and compare results between protected (left coronary grafted) and unprotected LMCA stenting in the current bare-metal stent era.


METHODS
We reviewed outcomes among 142 consecutive patients who underwent protected or unprotected LMCA stenting since 1997. All-cause mortality, myocardial infarction (MI), target-lesion revascularization (TLR), and the combined major adverse clinical event (MACE) rates at one year were computed.


RESULTS
Ninety-nine patients (70%) underwent protected and 43 patients (30%) underwent unprotected LMCA stenting. In the unprotected group, 86% were considered poor surgical candidates. Survival at one year was 88% for all patients, TLR 20%, and MACE 32%. At one year, survival was reduced in the unprotected group (72% vs. 95%, P<0.001) and MACE was increased in the unprotected patients (49% vs. 25%, P=0.005).


CONCLUSIONS
In the current era, stenting for both protected and unprotected LMCA disease is still associated with high long-term mortality and MACE rates. Stenting for unprotected LMCA disease in a high-risk population should only be considered in the absence of other revascularization options. Further studies are needed to evaluate the role of stenting for unprotected LMCA disease.
Kelley
Michael P
MP
Hospital of the University of Pennsylvania, University Health System, 9 Gates, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Klugherz
Bruce D
BD
Hashemi
Seyed M
SM
Meneveau
Nicolas F
NF
Johnston
Janet M
JM
Matthai
William H
WH
Banka
Vidya S
VS
Herrmann
Howard C
HC
Hirshfeld
John W
JW
Kimmel
Stephen E
SE
Kolansky
Daniel M
DM
Horwitz
Phillip A
PA
Schiele
Francois
F
Bassand
Jean-Pierre L
JP
Wilensky
Robert L
RL
D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012770:Shock, Cardiogenic / Q000209:etiology; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology