Results of Percutaneous Coronary Intervention of the Unprotected Left Main Coronary Artery in 143 Patients and Comparison of 30-Day Mortality to Results of Coronary Artery Bypass Grafting

• Published in: The American journal of cardiology Vol. 101; no. 1; pp. 75 - 81
• Main Authors: Dubois, Christophe, MD, Dens, Joseph, MD, PhD, Sinnaeve, Peter, MD, PhD, Belmans, Ann, MSc, Van Cleemput, Johan, MD, PhD, Mendez, Manuel, MD, Piessens, Jan, MD, PhD, Desmet, Walter, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2008; Elsevier; Elsevier Limited
• Subjects: Acute Coronary Syndrome - therapy; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Comparative analysis; Coronary Artery Bypass; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronary heart disease; Coronary Restenosis - epidemiology; Coronary vessels; Diseases of the cardiovascular system; Female; Heart; Heart surgery; Humans; Male; Medical sciences; Mortality; Myocardial Infarction - epidemiology; Outcome Assessment (Health Care); Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retreatment; Risk; Risk Adjustment; Sirolimus - administration & dosage; Sirolimus - analogs & derivatives; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Europe; Human; Prognosis; Angioplasty; Mortality; Coronary artery; Instrumentation therapy; Cardiovascular disease; Left coronary artery; Coronary heart disease; Epidemiology; Result; Coronary artery bypass; Graft; Circulatory system; Cardiology; Day; Comparative study
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2007.07.051

Percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (LMCA) is controversial. In 143 patients who underwent PCI of the unprotected LMCA, 30-day mortality was compared with predicted cumulative risk-adjusted perioperative surgical mortality based on logistic European System for Cardiac Operative Risk Evaluation. One-year clinical follow-up was completed in all patients. The overall major adverse cardiac event rate at 1 year was 34.3%, reflecting the high-risk profile of the patient population. Twelve patients (8%) experienced an acute myocardial infarction and 16 (11%) underwent target lesion revascularization. In 31 patients (22%) who died during the first year, median logistic European System for Cardiac Operative Risk Evaluation was 30%. Calculated RRs showed significantly lower 30-day mortality using PCI compared with predicted surgical mortality (RR 0.54, 95% confidence interval 0.31 to 0.86). Angiographic follow-up in 90 of the 118 patients alive at 6 months showed binary restenosis of 6% in patients treated with drug-eluting stents versus 29% in patients receiving bare-metal stents (p ≤0.01). In conclusion, PCI for unprotected LMCA disease was associated with acceptable short- and medium-term outcomes in patients at low to intermediate risk of bypass surgery. Mortality remains high in very high-risk patients unsuitable for surgery. However, in selected indications, PCI of the LMCA can offer an alternative to surgery, especially when using drug-eluting stents.