TITLE:
Percutaneous treatment of de novo unprotected left main stenosis in unselected consecutive patients: Experience of a high volume center
AUTHORS:
Elisabetta Varani, Sabine Vecchio, Matteo Aquilina, Giuseppe Vecchi, Marco Balducelli, Valeria Frassineti, Massimo Margheri
KEYWORDS:
Unprotected Left Main; Percutaneous Coronary Intervention
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.3 No.7,
October
9,
2013
ABSTRACT: Background: Percutaneous coronary intervention (PCI) has been increasingly employed to treat unprotected left main (ULM) stenosis, with hard endpoints similar to by-pass surgery, in patients selected by a Heart Team. Methods: From January 2008 to December 2011, 317 unselected and consecutive patients with de novo ULM stenosis underwent PCI with both bare metal (BMS) and drug-eluting (DES) stents. Major adverse cardiovascular events, target lesion (TLR) and vessel (TVR) revascularization were evaluated over a mean period of 590 ± 371 days. Results: Our population was characterized by a mean age 72 ± 10 years, high rate of acute coronary syndrome (ACS) (either with ST or non-ST elevation myocardial infarction, 15.5% and 35% respectively), severe comorbidity 16%, mean Euroscore 7 ± 3, mean Syntax Score 25 ± 9. In-hospital mortality was 6%. During the follow-up period, all-cause mortality was 16.7%, falling to 7% at the end of the follow-up, excluding patients presenting with ACS. TLR was observed and treated in 15% of patients. BMS utilization, age >75 years, ACS indication, Syntax Score >32 and associated peripheral artery disease were independent predictors of mortality at multivariate analysis. Conclusions: Stenting of ULM stenosis appears to be associated with a favorable mid-term outcome, even in an unselected population.