title: Percutaneous intervention of de novo unprotected left main stenosis in patients with acute coronary syndrome or stable coronary artery disease: in-hospital and long-term results.
abstract: OBJECTIVE
  to assess in-hospital and long-term results of the novo unprotected left main (UPLM) percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) or stable coronary artery disease (CAD), in an unselected population admitted to a single high- volume cathlab without on-site cardiac surgery.
  
  
  METHODS
  from 2008 to 2011, among 317 PCI performed in patients with the novo UPLM stenosis, 49 patients presented ST-elevation myocardial infarction (STEMI), 152 non ST-elevation MI/unstable angina (NSTEMI/UA), 116 stable CAD.
  
  
  RESULTS
  in-hospital mortality was 20% in STEMI, 5.3% in NSTEMI/UA and 1.7% in stable CAD patients (p<0.001). Two-year total mortality was 24.5%, 25.6% and 6% in the 3 groups, and cardiac death was 20%, 13.8% and 3.4% (p=0.002). Left main target lesion revascularization (TLR) was similar in the 3 groups, as the clinically- driven TLR (10% vs 11% vs 7.7% , p= 0.642), with neither definite nor probable stent thrombosis. Multivariate analysis showed the following independent predictors of 2-year mortality: bare-metal stent use (OR 4.53, p<0.001), Syntax score >32 (OR 3.53, p=0.012), ACS as the indication (OR 3.24, p=0.012), peripheral artery disease (OR 2.20, p=0.042), and age > 75 years (OR 2.09, p=0.05).
  
  
  CONCLUSIONS
  our experience showed acceptable results of UPLM PCI in STEMI patients, where short-term prognosis was related to hemodynamic conditions, good results in NSTEMI/UA patients where mortality increased in the follow-up due to comorbidities, and very good results in patients with stable CAD.
authors.affiliation: Cardiology Department, S. Maria delle Croci Hospital, Ravenna, Italy - ra.hocardioemo@ausl.ra.it.
authors.forename: E
authors.initials: E
authors.lastname: Varani
authors.forename: S
authors.initials: S
authors.lastname: Vecchio
authors.forename: M
authors.initials: M
authors.lastname: Aquilina
authors.forename: G
authors.initials: G
authors.lastname: Vecchi
authors.forename: M
authors.initials: M
authors.lastname: Balducelli
authors.forename: V
authors.initials: V
authors.lastname: Frassineti
authors.forename: M
authors.initials: M
authors.lastname: Margheri