title: Emergency management for critical left main coronary artery stenosis.
abstract: BACKGROUND
  Increased experience and improvements in technology seem to have encouraged the use of percutaneous interventions for left main coronary artery (LMCA) occlusions. There is no consensus, however, and the data are inadequate on whether surgery or percutaneous procedures should be the intervention of choice for critical occlusions.
  
  
  METHODS
  From January 2002 to December 2006, 108 patients with unprotected LMCA stenosis >80% were treated at our center. Eighty-three patients (77%) underwent bypass grafting and 20 (18%) underwent percutaneous intervention for the purpose of myocardial revascularization. We analyzed parameters demonstrated as risk factors for myocardial revascularization and their predicted effects on outcome.
  
  
  RESULTS
  Five patients (5%) died following emergency cardiopulmonary resuscitation before any intervention was performed. The early survival rate was 84.1% in the coronary bypass group and 63% in the percutaneous intervention group. The mean (±SD) survival time was 55.7 ± 2.6 months in the bypass group and 7.6 ± 1.3 months in the percutaneous group. The late-survival rate was also significantly higher in the bypass group. The mean late-survival time was 44.5 ± 3.6 months in the bypass group and 2.3 ± 0.8 months in the percutaneous group.
  
  
  CONCLUSIONS
  Although emergency percutaneous interventions are lifesaving in some cases, these results clearly demonstrate that coronary bypass grafting should be the intervention of choice for myocardial revascularization in patients with critical LMCA occlusion.
authors.affiliation: Siyami Ersek Thoracic, Cardiovascular Surgery Training and Research Hospital, 66 Ada, Atasehir, Istanbul, Turkey. onursokullu@gmail.com
authors.forename: Onur
authors.initials: O
authors.lastname: Sokullu
authors.forename: Numan Ali
authors.initials: NA
authors.lastname: Aydemir
authors.forename: Erol
authors.initials: E
authors.lastname: Kurc
authors.forename: Batuhan
authors.initials: B
authors.lastname: Ozay
authors.forename: Fuat
authors.initials: F
authors.lastname: Bilgen
authors.forename: Murat
authors.initials: M
authors.lastname: Demirtas
authors.forename: Serap Aykut
authors.initials: SA
authors.lastname: Aka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality*; D023921:Coronary Stenosis / Q000401:mortality* / Q000601:surgery*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology