The Safety and Clinical Outcome in Unprotected Intervention of Left Main Coronary Artery Stenosis in Maharat Nakhon Ratchasima Hospital
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Abstract
Background: Instead of coronary artery bypass graft (CABG) for critical or severe left main artery (LMCA) disease patients, up to now percutaneous coronary intervention (PCI) with drug-eluting stent (DES) is more frequently considered in unprotected LMCA stenosis. It might be due to co-morbidities, high surgical risk, and /or patient’s preference. Objective: To evaluate the safety and clinical outcome of PCI with DES (and BMS implantation) in unprotected LMCA in Maharat Nakhon Ratchasima Hospital. Patients & Methods: Retrospective review of the patients with LMCA who were treated with PCI with DES inspite of unprotected LMCA. The outcome and the immediate and late complications were i.e. major adverse cardiovascular and cerebral events (MACCE) and target vessel revascularization. The recruitment period was between October 2005 to October 2009. Results: Twenty-seven patients were enrolled, 20 of them (64%) were implanted with DES. The procedure was successful in all, but one was dead in hospital (3.7%) and two had MACCE (7.9%) in the hospital. The rest of them were followed within 6 to 48 months with repeated catheterization or 64-slides computerized tomography angiogram 19/27 (70.3%), 2 were additionally dead (7.4%), 7 developed MACCE within 6 months (25.9%) while 6 needed repeated target vessel revascularization (TVR) (22.2%). Conclusion: PCI with DES in cases of LMCA stenosis could be performed with high successful rate in spite of unprotected left main. Death rates were 3.7% and 7.4% as immediate and late complication respectively, 22.7% needed repeated TVR.
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