title: Left main PCI: An observational analysis from large single-centre experience.
abstract: BACKGROUND
  Although trials have shown efficacy of unprotected left main percutaneous coronary intervention (uLMPCI), data from Indian subcontinent are lacking. Hence, we planned this observational analysis of single-center uLMPCI data.
  
  
  OBJECTIVE
  To study long-term outcome after uLMPCI and identify predictors of adverse outcome.
  
  
  METHODS
  Case details of 62 consecutive patients of uLMPCI between 2006 and 2013 were retrieved from a computerized database wherein detailed records were maintained.
  
  
  RESULTS
  Mean follow-up duration was 669.8±404.2 days. Procedural success rate was 98.4%. Primary endpoint was composite of major adverse cardiovascular and cerebrovascular events (MACCE), which included cardiac death (CD), cerebrovascular accident (CVA), myocardial infarction (MI), and need for repeat intervention (RI) at three years. MACCE occurred in 13 (20.9%) patients. Cardiac death (CD), (including possible stent thrombosis), RI, and CVA occurred in 6 (9.7%), 5 (8%), and 2 (3.2%) patients, respectively. Overall three-year MACCE-free survival rate was 76.7%. Event-free survival rate was similar among patients who underwent uLMPCI alone and patients who underwent uLMPCI along with additional one-vessel PCI [(88.9% vs 81.8%), p=0.492], while survival rate was lower in patients who underwent uLMPCI along with PCI of additional two or more vessels (40%, p=0.036). Patients with syntax score ≤32 had higher event-free survival rate than those with syntax score >32 [(87.1% vs 33.3%), p=0.001]. Syntax score >32 was the only independent predictor of adverse outcome.
  
  
  CONCLUSIONS
  uLMPCI is safe and effective alternative to CABG for LM alone and LM plus single-vessel disease with syntax score ≤32.
authors.affiliation: Professor & Head of Cardiology, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. Electronic address: golf_pgi@yahoo.co.in.
authors.forename: Pravin K
authors.initials: PK
authors.lastname: Goel
authors.affiliation: Senior Resident, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Jatain
authors.affiliation: Assistant Professor Cardiology, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Roopali
authors.initials: R
authors.lastname: Khanna
authors.affiliation: Professor & Head of Biostatistics & Health Informatics, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: C M
authors.initials: CM
authors.lastname: Pandey
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005544:Forecasting; D006801:Humans; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Coronary artery bypass grafting; Drug-eluting stents; Left main; Percutaneous intervention