[Short- and medium-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery disease in patients who are poor candidates for surgical revascularization].
OBJECTIVE
Surgical revascularization is the procedure of choice for unprotected left main coronary artery stenosis, but it may be unsuitable in some patients. We report short- and medium-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery stenosis in a series of patients who were poor candidates for surgery.


METHODS
Descriptive study of a historic cohort of consecutive patients with unprotected left main coronary artery stenosis who were not candidates for surgery, treated with percutaneous coronary intervention at a single center between April 1999 and December 2003.


RESULTS
A total of 83 patients (mean age 72 [9] years) were included. Twenty patients (24%) were in shock on presentation. Surgery was considered unsuitable because of unacceptable surgical risk, poor condition of the distal vessels or comorbid conditions in 61 (73.5%) patients, or acute myocardial infarction in 22 (27%). An intraaortic balloon pump was used in 34 (40%); abciximab in 30 (36%) and stenting in 79 (95%) procedures. The intervention was considered successful in 76 patients (92%). Total in-hospital mortality was 28.9% (55% in patients with acute myocardial infarction and 20% in those without acute myocardial infarction). Median follow-up was 17 months. Average survival was 19.7 (2) months. Eighteen (22%) patients were hospitalized again for a new ischemic event, and 14 (17%) underwent revascularization. In 9 cases (10.8%) a new angioplasty was performed, and in 5 (6.0%) surgical revascularization was necessary.


CONCLUSIONS
Percutaneous coronary intervention is an option for revascularization in left main coronary artery stenosis in patients who are poor candidates for surgery, although in-hospital and long-term mortality remain high.
López-Palop
Ramón
R
Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. mlopezs@meditex.es
Pinar
Eduardo
E
Saura
Daniel
D
Pérez-Lorente
Fernando
F
Lozano
Iñigo
I
Teruel
Francisca
F
Hurtado
José
J
Lacunza
Javier
J
Picó
Francisco
F
Valdés
Mariano
M
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000517:prevention & control / Q000601:surgery; D009204:Myocardial Revascularization / Q000379:methods / Q000401:mortality*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome