title: Comparison of outcomes of unprotected left main versus multivessel coronary artery interventions.
abstract: Left main coronary artery (LMCA) percutaneous coronary intervention (PCI) has emerged as an appealing alternative to bypass surgery for significant LMCA disease, especially in high-risk candidates. PCI for unprotected LMCA stenosis is currently designated a class IIb indication. Direct comparisons between unprotected LMCA PCI and multivessel PCI are lacking. We aimed to determine the incremental risk associated with unprotected LMCA PCI compared to multivessel PCI. We queried the Cleveland Clinic PCI database to identify patients who underwent unprotected LMCA PCI from 2003 through 2009 and compared these to patients undergoing multivessel PCI in the same period. Patients undergoing PCI for acute myocardial infarction were excluded. Mortality was derived using the Social Security Death Index. Short-term (≤30-day) mortality rates in the LMCA PCI group (n = 468, 1.9%) were similar to the death rate in the multivessel PCI group (n = 1,973, 1.3%, p = 0.3). There was no significant difference in adjusted mortality between the 2 study groups. Stratifying LMCA PCI by the number of concomitant vessel territories treated, there was no significant difference in mortality in any LMCA PCI category (LMCA only, LMCA + 1-vessel PCI, LMCA + multivessel PCI) compared to multivessel PCI. In conclusion, there was comparable short-term and long-term mortality in the LMCA PCI and multivessel PCI groups. LMCA stenting did not appear to incur incremental risk compared to multivessel PCI.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
authors.forename: Tarique
authors.initials: T
authors.lastname: Zaman
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Mehdi
authors.initials: M
authors.lastname: Shishehbor
authors.forename: A Michael
authors.initials: AM
authors.lastname: Lincoff
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Whitlow
authors.forename: Christopher
authors.initials: C
authors.lastname: Bajzer
authors.forename: Irving
authors.initials: I
authors.lastname: Franco
authors.forename: Ravi
authors.initials: R
authors.lastname: Nair
authors.forename: Russell
authors.initials: R
authors.lastname: Raymond
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009820:Ohio / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome