Long-term outcome of percutaneous coronary intervention for unprotected left main coronary artery disease.

The aim of this study is to evaluate the in-hospital, 30 day and long-term outcomes after percutaneous coronary intervention for unprotected left main coronary artery disease. Left main coronary artery (LMCA) diseases stenosis is a strong indication for coronary artery bypass grafting (CABG). With improved device technology, percutaneous coronary intervention (PCI) with drug-eluting stent (DES) stents had been recently advocated as an alternative procedure for the unprotected LMCA disease. Between January 2003 and February 2007, all unprotected LMCA PCI procedures were retrospectively collected. Outcomes were obtained by chart record review and telephone interview. Fifty five consecutive patients with >50% diameter stenosis of LMCA undergoing PCI were analyzed. Indications for a percutaneous strategy were prohibitive surgical risks, or patient/physician preference. The procedural success rate was 98%. 41 patients (75%) received DES implantation. The majority of cases (n=33) were treated with a double-stent strategy. There were no in-hospital deaths. The clinical follow-up time was 867+/-410 days (range 20-1715). 18 (29%) patients experienced major adverse cardiac events, including 3 (5%) deaths, 4 (7%) myocardial infarctions, and 12 (21.8%) target lesion revascularizations (TLR) during follow-up. Multivariate analysis revealed hyperlipidemia (Hazard ratio, HR=6.2, p=0.024) and bifurcation involvement (HR=4.4, p=0.008) were independent predictors for MACE. Our results showed that PCI with stenting was an acceptable treatment option for patients with LMCA stenosis. Involvement of the LMCA bifurcation remains a predictor for unfavorable outcome.

Wu XM ，Liu CP ，Lin WC ，Kao HL ... -  《-》

Long-term outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN Medical Center-Left MAIN Re

This study sought to evaluate the long-term safety and effectiveness of percutaneous coronary intervention (PCI), as compared with coronary artery bypass grafting (CABG), for unprotected left main coronary artery (LMCA) disease. Data on the long-term (beyond 5-year) comparative results of treatment of unprotected LMCA disease with stent implantation or CABG are limited. We performed a 10-year clinical follow-up of 350 patients with unprotected LMCA disease who underwent PCI with bare-metal stents (BMS) (n = 100) or CABG (n = 250) from January 1995 to April 1999, and 5-year clinical follow-up of 395 patients with unprotected LMCA disease who underwent PCI with drug-eluting stents (DES) (n = 176) or CABG (n = 219) from January 2003 to May 2004. The primary safety end points were all-cause mortality and the composite of death, Q-wave myocardial infarction (MI), or stroke, and the primary efficacy end point was target vessel revascularization (TVR). In the 10-year follow-up cohort of BMS and concurrent CABG, the adjusted risks of death (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.44 to 1.50; p = 0.50) and the composite of death, Q-wave MI, or stroke (HR: 0.92; 95% CI: 0.55 to 1.53; p = 0.74) were similar between the 2 groups. The rate of TVR was significantly higher in the group that received BMS (HR: 10.34; 95% CI: 4.61 to 23.18; p < 0.001). In the 5-year follow-up cohort of DES and concurrent CABG, there was no significant difference in the adjusted risk of death (HR: 0.83; 95% CI: 0.34 to 2.07; p = 0.70) or the risk of the composite outcome (HR: 0.91; 95% CI: 0.45 to 1.83; p = 0.79). The rates of TVR were also higher in the DES group than the CABG group (HR: 6.22; 95% CI: 2.26 to 17.14; p < 0.001). For the treatment of unprotected LMCA disease, PCI with stent implantation showed similar long-term mortality and rates of death, Q-wave MI, or stroke. However, stenting, even with DES, was associated with higher rates of repeat revascularization than was CABG.

Park DW ，Kim YH ，Yun SC ，Lee JY ，Kim WJ ，Kang SJ ，Lee SW ，Lee CW ，Kim JJ ，Choo SJ ，Chung CH ，Lee JW ，Park SW ，Park SJ ... -  《-》

In-hospital and mid-term outcomes of stent implantation in patients with protected and unprotected left main coronary artery disease; King Chulalongkorn Memorial Hospital experiences.

Cholteesupachai J ，Udayachalerm W ，Srimahachota S ，Buddhari W ，Chaipromprasit J ，Songmuang SB ，Suithichaiyakul T ... -  《-》

Favorable long-term survival in patients undergoing stent PCI of unprotected left main coronary artery compared to predicted short-term prognosis of CABG estimated by EuroSCORE: clinical determinants of long-term outcome.

Lehmann R ，Spyridopoulos I ，Kremer J ，Zeiher AM ，Schächinger V ，Fichtlscherer S ... -  《-》

Efficacy of stenting for unprotected left main coronary artery disease in 297 patients.

Han YL ，Wang SL ，Jin QM ，Liu HW ，Ma YY ，Wang ZL ，Wang DM ，Luan B ，Wang G ... -  《CHINESE MEDICAL JOURNAL》