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Title: Percutaneous angioplasty in patients with left main coronary artery stenosis - long term clinical outcomes

Jan Z. Peruga, Jarosław D. Kasprzak, Michał Plewka, Tomasz Jeżewski, Anna Kopff, Maria Krzemińska-Pakuła
Original articles
Polish Journal of Cardiology
Start page:
Final page:
percutaneous angioplasty, left main coronary stenosis

Introduction: Left main coronary artery disease is found in 2.5-5% of patients undergoing cardiac catheterization for ischaemic chest pain, congestive heart failure or cardiogenic shock. Whereas pharmacological therapy of patients with left main disease is associated with poor prognosis, revascularisation by coronary artery bypass grafting (CABG) has been proved to improve prognosis and increase survival and thus is generally considered as a preferred therapeutic option. Aim of study: The aim of our study was to compare the long-term outcomes of coronary intervention in patients with left main disease. Material and metods: Over the past 4 years our experience we have performed LM stenting in 104 consecutive patients. The patients were divided in 3 subgroups according to the clinical status (l - STEM116 patients, II - NSTEMI 47 patients, III - unstable angina 41 patients). Results:The procedural success rate was 100%in group I, 97.5% in group II and 100% in group III. The groups I and II included patients in serious condition requiring use of intraaortic contrapulsation (75% and 38.3% respectively) and mechanical ventilation (in 6 patients in group I and 1 patient in II group). In-hospital and 1-year mortality rates were respectively: 31.2% and 43% in group I, 12.7% and 19.1% in grup II, 0% and 9.75% in grup III. was 31.2%, 12.7% and 0% respectively in I, II and III group. Composite end point (death, myocardial infarction, repeated revascularization) after 1-year occurred in 11 patients in I group (68.7%), 15 in II group (31.9%) and 7 in group III (17%). Conclusions: In high risk patients with ST segment elevation myocardial infarction (STEMI) due to left main stenosis (regardless of cardiogenic shock), left main angioplasty is nowadays the only alternative and should be performed. The patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) should also have angioplasty, although in selected cases, if the risk of PCI is to high (e.g. because of difficult anatomy), coronary artery bypass grafting is justified. In patients with unstable angina, but hemodynamically stable, left main PCI is feasible and is usually associated with good outcome. It especially concerns patients disqualified for CABG surgery, with Iow LV ejection fraction, having concomitant other serious medical conditions, as well as those who does not accept cardiosurgery.