In-hospital and mid-term outcomes of stent implantation in patients with protected and unprotected left main coronary artery disease; King Chulalongkorn Memorial Hospital experiences.
BACKGROUND
Left Main Coronary Artery (LMCA) disease is now uniformly treated with coronary artery by pass grafting (CABG). However some patients with LMCA disease did not receive CABG because of high operative risks as well as those who refused CABG Recent studies demonstrated the feasibility of stenting for LM stenosis, although data remain limited.


OBJECTIVE
To evaluate in-hospital and mid-term outcomes of using bare metal stent (BMS) and drug eluting stent (DES) in protected and unprotected left main coronary artery disease at King Chulalongkorn Memorial Hospital.


METHODS
Retrospective, single-center study. The authors reviewed the outcomes of patients who underwent percutaneous coronary intervention on left main coronary artery lesions in our hospital from July 2000 to August 2007. In-hospital data and clinical follow-up outcomes were analyzed and determined as in-hospital and mid-term mortality, major adverse cardiac event (MACE).


RESULTS
In eight years the authors reviewed 64 consecutive protected and unprotected LMCA patients who underwent PCI with stent placement. Altogether left main coronary artery stents were successfully deployed in all patients. DES usage was 64%. Bifurcation technique for distal left main coronary artery was executed in 32 patients (50%), included single stent in 62 (97%), two stents in 2(3%). Final kissing ballon inflation was done in 14 (21.9%). In-hospital mortality was 4.7% (three patients), two patients died from cardiac origin. The total in-hospital major adverse cardiac event (MACE) was 4.7%. Clinical follow-up of 6 months was completed in 100% of patients. Fifty percent of patients had angiographic follow-up and in-stent restenosis rate was 9.7%. No further death was noted and MACE at 6 months was 9.4%. Moreover, overall mean and median follow-up period were 31 +/- 25 months (range, 6-93 months) and 26 months respectively.


CONCLUSIONS
Stent Implantation was technically feasible and safely applied for the treatment ofprotected and unprotected left main coronary artery lesions in patients, with acceptable in-hospital and mid-term outcomes. More randomized and controlled clinical trials are needed to confirm the long-term effects of stents for LMCA disease.
Cholteesupachai
Jiranut
J
Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Udayachalerm
Wasan
W
Srimahachota
Suphot
S
Buddhari
Wacin
W
Chaipromprasit
Jarkarpun
J
Songmuang
Smonporn Boonyaratavej
SB
Suithichaiyakul
Taworn
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome