title: Angioplasty of unprotected left main coronary stenosis: Real world experience of a single-operator group from eastern India.
abstract: BACKGROUND
  Coronary artery bypass graft surgery is the standard treatment of unprotected left main coronary stenosis (ULMCA). However, in the real world scenario, many of these patients are unfit for CABG or prefer angioplasty as an alternative when offered the choice.
  
  
  METHODS
  A total of 86 clinically stable patients with ULMCA stenosis who were unfit or unwilling for CABG underwent PCI with DES at two tertiary care centers in Kolkata. Patients were followed up prospectively for a median of 34.6 months for major adverse cardiovascular events. Angiographic follow-up was done after 1 year of index procedure or earlier, if indicated.
  
  
  RESULTS
  Fifty-five patients (64%) had distal left main stenosis. Two-stent technique was used in 19 patients (22%) and single-stent technique in 36 patients (42%) with distal left main lesion. Thirteen patients (15.1%) had left ventricular ejection fraction (LVEF) of ≤45%. There was no in-hospital death, MI, or stent thrombosis. During follow-up, major adverse cardiac event (MACE) occurred in 9 patients (10.5%). Our study revealed significantly greater MACE in patients with distal left main lesion with LVEF ≤45% (50% vs 6.38%, p=0.0002), high SYNTAX score (36.36% vs 6.82%, p=0.008), and diabetes (17.95% vs 0.00%, p=0.07). Overall, also patients with Diabetes, LVEF ≤ 45%, and SYNTAX score >32 had significantly higher MACE. Use of IC Stent, IVUS, or procedural strategy in distal lesion did not affect MACE.
  
  
  CONCLUSIONS
  In selective patients with low-intermediate SYNTAX score and without diabetes and LV dysfunction, ULMCA PCI with DES is feasible.
authors.affiliation: Chief of Cardiac Intervention, Fortis Hospital, Anandapur, Kolkata, India. Electronic address: shuvananray@gmail.com.
authors.forename: Shuvanan
authors.initials: S
authors.lastname: Ray
authors.affiliation: Head of the Department of Cardiology, B.R. Singh Hospital, Kolkata, India.
authors.forename: Alok
authors.initials: A
authors.lastname: Mazumder
authors.affiliation: Visiting Consultant of Cardiology, Fortis Hospital, Anandapur, Kolkata, India.
authors.forename: Soumitra
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Associate Consultant of Cardiology, Fortis Hospital, Anandapur, Kolkata, India.
authors.forename: Prithwiraj
authors.initials: P
authors.lastname: Bhattacharjee
authors.affiliation: Consultant Interventional Cardiologist, Fortis Hospital, Anandapur, Kolkata, India.
authors.forename: David
authors.initials: D
authors.lastname: Rozario
authors.affiliation: Consultant Interventional Cardiologist, Fortis Hospital, Anandapur, Kolkata, India.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Bandyopadhyay
authors.affiliation: Consultant Interventional Cardiologist, Fortis Hospital, Anandapur, Kolkata, India.
authors.forename: Sanjeev S
authors.initials: SS
authors.lastname: Mukherjee
authors.affiliation: Professor and Ex Head of the Department of Cardiology, ESI Hospital Maniktala, Kolkata, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Deb
authors.affiliation: Ex Consultant Cardiologist, I.P.G.M.E.&R. & S.S.K.M. Hospital, Kolkata, India.
authors.forename: Amal
authors.initials: A
authors.lastname: Bandyopadhyay
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: Drug eluting stents; Percutaneous coronary intervention; Unprotected left main coronary artery