Long-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery disease.
BACKGROUND
This study evaluates the in-hospital, 30 day and long-term results of stenting for unprotected left main coronary artery disease in our institution.


METHODS
Between April 2001 and October 2005 all unprotected left main cases were retrospectively reviewed. Outcomes were obtained by case note review and postal questionnaire; primary care physicians were contacted to complete missing data.


RESULTS
We identified 100 consecutive patients who underwent unprotected left main procedures, 1.44% of the institution PCI volume. Indications for a percutaneous strategy were non-surgical candidates (47), emergency revascularisation (25) and patient/physician preference (28). Overall procedural success was 97%. The majority of cases (n=78) were performed with a single-stent strategy. 55% received a drug-eluting stent. There were 7 in-hospital deaths, 5 in the emergency group (cardiogenic shock) and 2 non-CABG candidates. Post hospital discharge long-term clinical follow-up was 651+/-431 days (range 6-1741). There were 8 deaths post discharge. Patients presenting as an emergency had a 72% survival rate at long-term follow-up, non-surgical candidates 83%, and patient/physician preference group had a 100% long-term survival. Multivariate analysis revealed cardiogenic shock (HR=7.9, 95% CI 1.7-3.6, p=0.008), failed thrombolysis (HR=8.5, 95% CI 1.7-41.7, p=0.008) and use of a bare-metal stent (HR=4.4, 1.1-17.0, p=0.034) were independent predictors of mortality.


CONCLUSIONS
Our data suggest that in contemporary practice stenting for unprotected left main disease can be considered as an alternative treatment to surgery for selected patients. The results of randomised controlled trials are awaited.
Schrale
Ryan G
RG
Department of Cardiology, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom. rschrale@hotmail.com
van Gaal
W
W
Channon
K M
KM
Forfar
J C
JC
Ormerod
O J
OJ
Banning
A P
AP
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality* / Q000639:trends*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013995:Time; D016896:Treatment Outcome