title: Results of percutaneous coronary intervention of the unprotected left main coronary artery in 143 patients and comparison of 30-day mortality to results of coronary artery bypass grafting.
abstract: Percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (LMCA) is controversial. In 143 patients who underwent PCI of the unprotected LMCA, 30-day mortality was compared with predicted cumulative risk-adjusted perioperative surgical mortality based on logistic European System for Cardiac Operative Risk Evaluation. One-year clinical follow-up was completed in all patients. The overall major adverse cardiac event rate at 1 year was 34.3%, reflecting the high-risk profile of the patient population. Twelve patients (8%) experienced an acute myocardial infarction and 16 (11%) underwent target lesion revascularization. In 31 patients (22%) who died during the first year, median logistic European System for Cardiac Operative Risk Evaluation was 30%. Calculated RRs showed significantly lower 30-day mortality using PCI compared with predicted surgical mortality (RR 0.54, 95% confidence interval 0.31 to 0.86). Angiographic follow-up in 90 of the 118 patients alive at 6 months showed binary restenosis of 6% in patients treated with drug-eluting stents versus 29% in patients receiving bare-metal stents (p < or =0.01). In conclusion, PCI for unprotected LMCA disease was associated with acceptable short- and medium-term outcomes in patients at low to intermediate risk of bypass surgery. Mortality remains high in very high-risk patients unsuitable for surgery. However, in selected indications, PCI of the LMCA can offer an alternative to surgery, especially when using drug-eluting stents.
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Leuven, Belgium. christophe.dubois@uz.kuleuven.ac.be
authors.forename: Christophe
authors.initials: C
authors.lastname: Dubois
authors.forename: Joseph
authors.initials: J
authors.lastname: Dens
authors.forename: Peter
authors.initials: P
authors.lastname: Sinnaeve
authors.forename: Ann
authors.initials: A
authors.lastname: Belmans
authors.forename: Johan
authors.initials: J
authors.lastname: Van Cleemput
authors.forename: Manuel
authors.initials: M
authors.lastname: Mendez
authors.forename: Jan
authors.initials: J
authors.lastname: Piessens
authors.forename: Walter
authors.initials: W
authors.lastname: Desmet
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D019233:Retreatment; D020379:Risk Adjustment; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D015607:Stents
chemical_list: C518022:umirolimus; D020123:Sirolimus