title: Real World Application of Stenting of Unprotected Left Main Coronary Stenosis: A Single-Center Experience.
abstract: BACKGROUND
  The aim of this study was to summarize our single-center real-world experience with percutaneous coronary intervention (PCI) stenting of unprotected left main coronary artery (ULMCA). PCI-stenting of the ULMCA, while controversial, is emerging as an alternative to coronary artery bypass graft (CABG) surgery in select patients and clinical situations.
  
  
  METHODS
  Between January 2005 and December 2008, PCI-stenting was performed on 125 patients with ULMCA lesions at our institution. Clinical and procedural data were recorded at the time of procedure, and patients were followed prospectively (mean 1.7 years; range 1 day-4.1 years) for outcomes, including death, myocardial infarction (MI), and target vessel revascularization (TVR).
  
  
  RESULTS
  The majority of cases were urgent or emergent (82.5%), 50.4% of patients were non-surgical candidates, and 63.2% had 3 vessel disease. Many emergent patients presented in shock (62.1%), were not surgical candidates (89.7%), and had high mortality (20.7% in-hospital, 44.8% long-term). Mortality in the elective group was 6.3%. Cumulative death and TVR rates were 28.8% and 13.6%, respectively. Independent predictors of mortality were ejection fraction (EF) ≤ 35% (HR 2.4, CI 1.1 - 5.4) and left main bifurcation (HR 2.7, CI 1.2 - 5.7).
  
  
  CONCLUSIONS
  PCI-stenting is a viable option in patients with LMCA disease and extends options to patients who are poor candidates for CABG. Elective PCI in low-risk CABG patients results in good long-term survival. Cumulative TVR is 13.6%. EF ≤ 35% and left main bifurcation are independently associated with increased mortality.
authors.affiliation: Section of Cardiology, Department of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Calvin C
authors.initials: CC
authors.lastname: Leung
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Ball
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sidhu
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: DeVries
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Jayne
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Robb
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Aaron V
authors.initials: AV
authors.lastname: Kaplan
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Malenka
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
keywords: Cardiac catheterization; Left main coronary artery; Percutaneous intervention; Stenting