Acute and long-term outcome of unprotected left main coronary angioplasty compared to the anticipated surgical risk.
OBJECTIVE
Percutaneous coronary intervention of unprotected left main (ULM) stenosis is increasing despite surgical revascularisation being the recommended treatment by the current guidelines. We compared the 30-day and 9-month mortality after ULM stenting with the predicted surgical outcome as determined by the EuroSCORE.


RESULTS
We included 81 consecutive patients who underwent ULM stenting. The patient cohort was divided into a normal risk group (EuroSCORE <or=5, predicted 30-day mortality <3%), and a high-risk group (EuroSCORE >5, predicted 30-day mortality 11%). Follow-up examinations were scheduled for one and nine months after the initial PCI. The average EuroSCOREs in the normal- and high-risk group were 3.0 (29 patients, 36%) and 10.0 (52 patients, 64%), respectively. Mortality rates at 30 days were 3% in the normal-risk group and 8% in the high-risk group. Subacute stent thrombosis occurred in 3.4% (three patients) undergoing elective PCI. Major adverse cardiac events during the nine months follow-up were registered in 24% of patients in the normal-risk group, and in 27% of the patients in the high-risk group.


CONCLUSIONS
Short-term outcome of ULM stenting in our high-risk patients is comparable to surgical outcome predicted by the EuroSCORE. Long-term outcome was less favourable due to a high mortality rate. ULM stenting in patients with low surgical risk could be associated with higher mortality rates compared to CABG because of the unpredictable risk of a fatal stent thrombosis.
Rademacher
Wilma
W
Department of Cardiology, University Hospital of Jena, Jena, Germany. Wilma.Rademacher@med.uni-jena.de
Knape
Alexander
A
Schumm
Julia
J
Ferrari
Markus
M
Lauten
Alexander
A
Mudra
Harald
H
Figulla
Hans R
HR
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D023921:Coronary Stenosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D013927:Thrombosis / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome