title: Long-term follow-up after percutaneous treatment of the unprotected left main stenosis in high risk patients not suitable for bypass surgery.
abstract: OBJECTIVE
  Percutaneous coronary intervention is recommended in patients with unprotected left main stenosis non suitable for coronary artery bypass graft. Long-term follow-up of those patients remains uncertain.
  
  
  METHODS
  All patients with de novo unprotected left main stenosis treated with stent implantation were consecutively enrolled. Percutaneous coronary intervention was indicated according to the standards of care, taking into account clinical and anatomical conditions unfavorable for coronary artery bypass graft. The primary end point was the occurrence of major adverse cardiac events, a composite of death, nonfatal acute myocardial infarction, or target lesion revascularization.
  
  
  RESULTS
  Of 226 consecutive patients included, 202 (89.4%) were treated with drug-eluting stents. Mean age was 72.1 years, 41.1% had renal dysfunction, and mean Syntax score and EuroSCORE were 28.9 and 7.4, respectively. Angiographic and procedural success was achieved in 99.6% and 92.9% of patients. At 3 years, the rates of major adverse cardiac events, death, nonfatal acute myocardial infarction and target lesion revascularization were 36.2%, 25.2%, 8.4%, 8.0%, respectively. Target lesion revascularization was more frequently observed when ≥ 2 stents were implanted rather than a single stent (18.5% vs 5.8%, P=.03); and with bare metal stents rather than drug-eluting stents (13.0% vs 7.9%, P=.24). Definite stent thrombosis was observed in 2 patients (0.9%) and probable stent thrombosis in 7 (3.1%). Female sex, impaired left ventricular function, and use of bare metal stents were significantly related with all-cause mortality.
  
  
  CONCLUSIONS
  High-risk patients with unprotected left main stenosis treated with percutaneous coronary intervention presented with a high rate of major adverse cardiac events at long-term follow-up. Female sex, impaired left ventricular function, and use of bare metal stents were predictors of poor prognosis.
authors.affiliation: Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. 26587jgh@comb.cat
authors.forename: Joan Antoni
authors.initials: JA
authors.lastname: Gómez-Hospital
authors.forename: Josep
authors.initials: J
authors.lastname: Gomez-Lara
authors.forename: Juan
authors.initials: J
authors.lastname: Rondan
authors.forename: Silvia
authors.initials: S
authors.lastname: Homs
authors.forename: Iñigo
authors.initials: I
authors.lastname: Lozano Martínez-Luengas
authors.forename: Jose Luís
authors.initials: JL
authors.lastname: Ferreiro
authors.forename: Gerard
authors.initials: G
authors.lastname: Roura
authors.forename: Jaume
authors.initials: J
authors.lastname: Maristany
authors.forename: Luis
authors.initials: L
authors.lastname: Teruel
authors.forename: Amelia
authors.initials: A
authors.lastname: Carro
authors.forename: Pablo
authors.initials: P
authors.lastname: Avanzas
authors.forename: Paco
authors.initials: P
authors.lastname: Jara
authors.forename: Enric
authors.initials: E
authors.lastname: Esplugas
authors.forename: Cesar
authors.initials: C
authors.lastname: Moris
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D000075202:Contraindications; D001026:Coronary Artery Bypass / Q000401:mortality; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000209:etiology