title: One-year clinical outcomes of protected and unprotected left main coronary artery stenting.
abstract: 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.
authors.affiliation: Hospital of the University of Pennsylvania, University Health System, 9 Gates, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelley
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Klugherz
authors.forename: Seyed M
authors.initials: SM
authors.lastname: Hashemi
authors.forename: Nicolas F
authors.initials: NF
authors.lastname: Meneveau
authors.forename: Janet M
authors.initials: JM
authors.lastname: Johnston
authors.forename: William H
authors.initials: WH
authors.lastname: Matthai
authors.forename: Vidya S
authors.initials: VS
authors.lastname: Banka
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.forename: John W
authors.initials: JW
authors.lastname: Hirshfeld
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Kimmel
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Kolansky
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Horwitz
authors.forename: Francois
authors.initials: F
authors.lastname: Schiele
authors.forename: Jean-Pierre L
authors.initials: JP
authors.lastname: Bassand
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wilensky
mesh_terms: 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