title: Left main coronary angioplasty in surgical and nonsurgical candidates: putative role for a preconditioned expert culture on clinical outcome.
abstract: The impact of patient- and operator-related clinical variables of success and evaluation of subsequent midterm effects of percutaneous treatment of left main coronary stenosis were assessed at a tertiary-referral high-volume angioplasty center in a retrospective observational study. A total of 118 consecutive surgical and nonsurgical patients with protected and unprotected left main (LM) lesions were treated by operators within a preconditioned expert culture. There were 57 protected and 61 unprotected patients, including 13 patients with an acute myocardial infarction (AMI). Mean age was 67 years (range 33-90). The length of the stenotic segment was 4.8 +/- 2.3 mm, mean lumen diameter was 1.1 +/- 0.6 mm, and percentage diameter stenosis was 63.6 +/- 14.6%. There were 7 (5.9%) in-hospital cardiac deaths that presented with AMI and cardiogenic shock. All 7 patients presented with unprotected LM lesions. Average follow-up was 8 months (range 1-36 months). Major adverse cardiac events (MACE) during follow-up comprised 8 (6.8%) cardiac deaths, 3 (2.5%) myocardial infarctions, 8 (6.8%) subjects with coronary bypass surgery, and 16 (13.6%) repeated angioplasties. The total event rate (MACE, n = 43) at the end of the follow-up period was 36.4%. There were more MACE in the unprotected group than in the protected group (41% vs. 31.6%, P<0.05). This study supports prior data on LM angioplasty. LM stenting in AMI showed less favorable in-hospital and late outcome.
authors.affiliation: Department of Cardiology, Medical Centre, Alkmaar, The Netherlands.
authors.forename: Johannes O J
authors.initials: JO
authors.lastname: Peels
authors.forename: Willem-Peter T
authors.initials: WP
authors.lastname: Ruifrok
authors.forename: Gillian A J
authors.initials: GA
authors.lastname: Jessurun
authors.forename: Raymond W M
authors.initials: RW
authors.lastname: Hautvast
authors.forename: Ad J
authors.initials: AJ
authors.lastname: van Boven
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Rene A
authors.initials: RA
authors.lastname: Tio