Copyright © 2003 by the European Society of Cardiology.
Regular Articles
One-year clinical outcomes of protected and unprotected left main coronary artery stenting
a University of Pennsylvania Health System, Philadelphia, PA, USA
b Hôpital Jean Minjoz,Besancon, France
c University of Pittsburgh, Pittsburgh, PA, USA
* Corresponding author: Robert L. Wilensky, MD, Associate Professor of Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce Street, Philadelphia, PA 19104, USA. Tel.: +1-215-615-3060; fax: +1-215-615-3073
E-mail address: robert.wilensky{at}uphs.upenn.edu
Received 26 November 2002; revised 5 May 2003; accepted 28 May 2003
Aims To evaluate outcomes for left main coronary artery (LMCA) stenting and compare results between protected (left coronary grafted) and unprotected LMCA stenting in the current bare-metal stent era.
Methods We reviewed outcomes among 142 consecutive patients who underwent protected or unprotected LMCA stenting since 1997. All-cause mortality, myocardial infarction (MI), target-lesion revascularization (TLR), and the combined majoradverse clinical event (MACE) rates at one year were computed.
Results Ninety-nine patients (70%) underwent protected and 43 patients (30%) underwent unprotected LMCA stenting. In the unprotected group, 86% were considered poor surgical candidates. Survival at one year was 88% for all patients, TLR 20%, and MACE 32%. At one year, survival was reduced in the unprotected group (72% vs. 95%, P<0.001) and MACE was increased in the unprotected patients (49% vs. 25%, P=0.005).
Conclusions In the current era, stenting for both protected and unprotected LMCA disease is still associated with high long-term mortality and MACE rates. Stenting for unprotected LMCA disease in a high-risk population should only be considered in the absence of other revascularization options. Further studies are needed to evaluate the role of stenting for unprotected LMCA disease.
Key Words: Cardiogenic shock • Coronary artery bypasssurgery • Coronary artery disease • Left main disease • Percutaneous coronaryintervention
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