Coronary artery diseaseLong-Term Clinical and Angiographic Outcomes of Treatment of Unprotected Left Main Coronary Artery Stenosis With Sirolimus-Eluting Stents
Section snippets
Methods
From a total population of 2,126 consecutive patients referred for coronary angiography to our institution (a tertiary academic care center with an annual caseload of >1,000 percutaneous coronary interventions) between November 2002 and December 2004 because of established or suspected coronary artery disease, we prospectively enrolled 85 consecutive patients (4.0%) with significant LM stenosis (≥50% diameter stenosis by visual estimate), coronary anatomy suitable for percutaneous
Results
Baseline clinical and angiographic characteristics are listed in Table 1, Table 2. Patients’ mean age was 68 ± 10 years; 24 patients (28%) patients had previous percutaneous coronary intervention on other coronary vessels, 20 (24%) had peripheral artery disease, and 4 (5%) chronic renal failure; and ejection fraction was 52 ± 10%. The principal clinical indication for referral was unstable angina in 40 (47%) followed by acute myocardial infarction in 17 (20%), with ST-elevation myocardial
Discussion
The present study suggests that use of drug-eluting stents to treat LM disease in unselected patients without major contraindications to cardiac surgery may be feasible, safe, and associated with a high procedural success rate. These findings are based on the lack, in our population, of episodes of stent thrombosis and on the very low incidence of procedure-related complications and in-hospital adverse events rate although many procedures were primary angioplasties for ST-elevation myocardial
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Cited by (43)
Left main coronary stenting in a non surgical octogenarian population: A possible approach
2012, Cardiovascular Revascularization MedicineCitation Excerpt :Percutaneous coronary intervention (PCI) of unprotected LMCA has increased with improvements in equipment, interventional techniques, and drug therapy [5]. Indeed, the wide diffusion of drug eluting-stent (DES) that significantly reduces the restenosis and the repeat target vessel revascularization (TVR) has improved the outcome of PCI for these lesions [6–27]. Despite the compelling evidence supporting the PCI with a DES [28] and the reduction in cardiac events during the peri-interventional period [8,14,17], LMCA lesions continue to be treated surgically because recent randomized trials failed to prove superiority or at least non-inferiority of DES for unprotected LMCA stenosis compared with CABG [2,22].
Routine versus selective coronary artery bypass for left main coronary artery revascularization: The appraise a customized strategy for left main revascularization (CUSTOMIZE) study
2011, International Journal of CardiologyCitation Excerpt :The introduction of drug-eluting stents (DES) in clinical practice has significantly reduced the risk of restenosis and reintervention over time, leading to their rapid widespread and extensive use, even for more complex, off-label lesions such as ULMCA stenosis [13]. The excellent results obtained with DES suggest that these devices can be an effective and safe alternative to CABG when treating left main disease in cases with anatomy suitable for percutaneous intervention [14–18]. The SYNTAX study, the first randomized, controlled clinical trial to compare DES to CABG in patients with ULMCA, has recently concluded that CABG remains the standard of care for three-vessel or left main coronary artery disease, as due to lower rates of the combined endpoint of major adverse cardiac or cerebrovascular events at 1 year [19].
5-year outcomes following percutaneous coronary intervention with drug-eluting stent implantation versus coronary artery bypass graft for unprotected left main coronary artery lesions: The Milan experience
2010, JACC: Cardiovascular InterventionsCitation Excerpt :Some retrospective studies evaluating surgical treatment for this disease reported an in-hospital mortality rate varying from 1.7% to 7.0% and a 1-year mortality rate of 6% to 14% (18–21). Encouraging 1-year and more recently 3-year results have been reported for PCI with DES implantation in this particular subset of patients (2–11). Observational, nonrandomized registries (5,13,16) reported thus far have shown no difference in the occurrence of MACCE between patients treated with DES compared with the ones treated with CABG in this subset of patients.