Acute and intermediate-term results of percutaneus left main coronary artery interventions.
BACKGROUND
Left main coronary artery disease is considered a surgical indication in most centers. However, in some cases prohibited from surgery or in patients with prior bypass grafting, there is a need for percutaneous coronary intervention in LMCA disease scenarios.


OBJECTIVE
To assess the clinical outcomes among patients undergoing stent-based LMCA angioplasty.


METHODS
We identified 34 consecutive patients who underwent PCI in LMCA at our institution. Procedural data and clinical outcomes were obtained for all patients.


RESULTS
The mean age was 71 +/- 12 years. There were 27 elective and 7 emergent procedures performed on 23 "protected" LMCA and 11 "unprotected" LMCA. In emergent procedures, the prevalence of cardiogenic shock (29% vs. 0%, P = 0.04) in patients with prior coronary bypass (29% vs. 8.5%, P = 0.007) was significantly higher compared to elective cases. Procedural success in emergent procedures was significantly lower than in elective procedures (71 vs. 100%, P = 0.04). In emergent versus elective procedures, the in-hospital mortality rate was higher (43 vs. 0%, P = 0.006). The rate of cumulative major adverse cardiac events at 1 and 6 months was 43% and 71% in emergent cases versus 0% and 33% in elective cases (P < 0.05 for both comparisons). In patients with "unprotected" LMCA the overall rate of major cardiac events at 1 month was higher compared to "protected" LMCA patients (27 vs. 0%, P = 0.02). Multivariate analysis revealed emergent procedure as an independent predictor for mortality and adverse cardiac events (odds ratio 6.7, 95% confidence interval 1.2-36; P = 0.02).


CONCLUSIONS
Percutaneous interventions in LMCA are feasible and relatively safe in carefully selected cases. Procedural outcomes and clinical prognosis is highly dependent on the nature of disease prior to angioplasty (e.g., elective vs. emergent procedure) as well as on protection of the LMCA by patent grafts.
Teplitsky
Igal
I
Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
Asali
Abid
A
Vaknin
Hana
H
Golovchiner
Gregory
G
Fuchs
Shmuel
S
Battler
Alexander
A
Kornowski
Ran
R
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D023921:Coronary Stenosis / Q000628:therapy*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome