title: Emergent versus elective percutaneous stent implantation in the unprotected left main: long-term outcomes from a single-center registry.
abstract: BACKGROUND
  Unprotected left main (ULM) coronary disease is considered by contemporary guidelines a class I indication for surgery. However, percutaneous coronary intervention (PCI) is often carried out in the ULM in either emergent or high-risk elective procedures. The aim of this study was to evaluate ULM-PCI as a feasible and safe procedure in the emergent setting, and to analyze outcomes in both scenarios.
  
  
  METHODS
  Angiographic and clinical data were collected retrospectively for all patients who underwent emergent or elective PCI on ULM at our center from January 2006 to June 2009. All patients were followed up with a clinical visit or telephone interview. Main outcomes included major adverse cardiac events (MACE) and its individual components: cardiac death, myocardial infarction (MI) and target lesion revascularization. These were analyzed at the longest follow-up available.
  
  
  RESULTS
  A total of 98 consecutive patients with significant LM disease were included. Fifty-seven of them were treated as a planned procedure (elective group) and 41 as an emergent procedure (emergent group). Procedural success was achieved in 100% of cases in the elective group and in 88% of the emergent group (p = 0.011). Higher use of drug-eluting stents (DES) was recorded in the elective group (75% versus 45% in the emergent group; p <0.002). The emergent group presented a higher in-hospital mortality (24% versus 2% in the elective group; p <0.001). At a mean follow-up of 626 ± 380 days, the overall MACE rate was similar betweeen the two groups (23% in the emergent group versus 17% in the elective group; p = 0.52). Independent predictors of MACE after discharge follow-up were postprocedure minimal diameter and DES use.
  
  
  CONCLUSIONS
  Emergent PCI of the ULM exhibits worse in-hospital outcomes as compared to elective procedures. However, after discharge, long-term outcomes remain comparably good between groups.
authors.affiliation: Department of Cardiology, Clinic Thorax Institute, Hospital Clinic de Barcelona, Villaroel 170, Planta 6 Esc 3, 08036, Barcelona, Spain. masabate@clinic.ub.es
authors.forename: Victoria
authors.initials: V
authors.lastname: Martin-Yuste
authors.forename: Luis
authors.initials: L
authors.lastname: Alvarez-Contreras
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-Gonzalez
authors.forename: Clarissa
authors.initials: C
authors.lastname: Cola
authors.forename: Joan
authors.initials: J
authors.lastname: Garcia-Picart
authors.forename: Vicens
authors.initials: V
authors.lastname: Martí
authors.forename: Manel
authors.initials: M
authors.lastname: Sabate
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D023921:Coronary Stenosis / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D003402:Creatine Kinase / Q000097:blood; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D054855:Drug-Eluting Stents; D017558:Elective Surgical Procedures; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D003402:Creatine Kinase