title: Stent implantation for the unprotected left main coronary artery. The long-term outcome of 62 patients.
abstract: BACKGROUND
  Stent implantation for the unprotected left main coronary artery (ULMCA) is regarded as controversial and coronary heart disease with LMCA stenosis still remains a basic indication for bypass surgery. Although there is no doubt that the risk of stent implantation for LMCA lesions is low, there are still limited data on long-term outcomes. There have been no reports so far answering the question whether ULMCA stenting ensures adequate coronary blood flow in the vessel.
  
  
  OBJECTIVE
  Assessment of the effect of LMCA flow restoration with stenting on the coronary flow reserve assessed by an exercise test, as well as on left ventricular function and angina in patients followed for 12 months after the procedure.
  
  
  METHODS
  The study population included 62 patients (17 women and 45 men) aged 61.4+/-11.1 (35-84 years) who underwent coronary angioplasty with elective ULMCA stenting. In all patients, serial echocardiography (before and 1, 3, 6, and 12 months after the procedure) and the exercise test according to the Bruce protocol (1, 3, 6, 12 months after the procedure) were carried out. Routine coronary angiography was performed 3 to 6 months after the procedure. Fifty-nine patients (95.2%) survived a 12-month period. In 24 (38.7%) patients major adverse cardiac events (MACE) occurred. In-stent restenosis was observed in 13 patients; in 11 of them repeated PCI was performed and 2 of them underwent CABG. One patient after repeated PCI required CABG.
  
  
  RESULTS
  Severity of angina, evaluated according to the CCS scale, decreased significantly in the 12-month follow-up period as compared with the preprocedural period (p <0.00001). The mean baseline left ventricular ejection fraction was 51.6+/-12.5%. It increased to 53.8+/-12.8% (p <0.02) at 6 months and remained at this level at 12 months. The mean exercise test time was 7.0+/-3.4 minutes in the first month after ULMCA stenting, and in the sixth and the twelfth month of follow-up it increased to 7.6+/-3.4 minutes (p <0.002) and 7.8+/-3.2 minutes (p <0.05), respectively. The metabolic equivalent task (MET) value did not change significantly during the observation period.
  
  
  CONCLUSIONS
  Restoration of the physiological blood flow in the unprotected left main coronary artery with stent implantation is associated with a significant reduction of angina, significant improvement of the left ventricular systolic function and preservation of exercise capacity in long-term follow-up.
authors.affiliation: Oddział Ostrych Zespołów Wieńcowych SPSK nr 7, ul. Ziołowa 45/47, 40-635 Katowice. ewapeszek@interia.pl
authors.forename: Ewa
authors.initials: E
authors.lastname: Peszek-Przybyła
authors.forename: Paweł
authors.initials: P
authors.lastname: Buszman
authors.forename: Bozena
authors.initials: B
authors.lastname: Białkowska
authors.forename: Laeksander
authors.initials: L
authors.lastname: Zurakowski
authors.forename: Iwona
authors.initials: I
authors.lastname: Banasiewicz-Szkróbka
authors.forename: Marcin
authors.initials: M
authors.lastname: Debiński
authors.forename: Michał
authors.initials: M
authors.lastname: Tendera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents