The Impact of Routine Angiographic Follow-Up in a Population of Patients Undergoing Percutaneous Coronary Intervention Within the Left Main Coronary Artery

Background: Concomitant left main coronary artery (LMCA) disease in patients with chronic total occlusions (CTO) commonly results in referral for coronary artery bypass grafting, although the impact of LMCA in CTO patients remains largely unknown. Nevertheless, patient selection for percutaneous coronary intervention of CTOs (CTO-PCI) or alternative revascularization strategies should be based on precise evaluation of the coronary anatomy to anticipate those patients that most likely benefit from a procedure and not on strict adherence to perpetual clinical practice. Therefore, the aim of this study was to assess the impact of LMCA disease on long-term outcomes in patients undergoing percutaneous coronary intervention for CTO. Methods: We enrolled 3860 consecutive patients undergoing PCI for at least one CTO lesion and investigated the predictive value of concomitant LMCA disease. All-cause mortality was defined as the primary study endpoint. Results: We observed that LMCA disease is significantly associated with mortality. In the Cox regression analysis, we observed a crude hazard ratio (HR) 1.59 (95% confidence interval (CI) 1.23–2.04, p < 0.001) for patients with LMCA disease as compared to patients without. Results remained unchanged after bootstrap- or clinical confounder-based adjustment. Conclusion: LMCA disease is associated with excess mortality in CTO patients. Specifically, anatomical features such as CTO of the circumflex artery represent a high risk patient population.

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Abstract 1846: Coronary Artery Bypass Surgery is superior to Percutaneous Coronary Intervention With Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease

Circulation ◽

10.1161/circ.116.suppl_16.ii_394-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Gengo Sunagawa ◽

Tatsuhiko Komiya ◽

Nobushige Tamura ◽

Taira Kobayashi ◽

Tomokuni Furukawa ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Left Main Coronary Artery ◽

Artery Bypass ◽

Coronary Intervention ◽

Drug Eluting Stents ◽

Left Main ◽

Percutaneous Coronary ◽

Drug Eluting

(Introduction) Improvements in results of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have been extending their use in patients with unprotected left main coronary artery (ULMCA) disease. (Hypothesis) We assessed the hypothesis that coronary artery bypass grafting (CABG) would be superior to PCI with DES in patients with ULMCA. (Methods) From January 2004 to March 2006, 114 patients underwent CABG (emergency: 42 cases), and 136 patients underwent PCI with DES (emergency: 9 cases) for ULMCA disease. In CABG, 91 patients had off-pump surgery. In PCI, all patients had sirolimus-eluting stent implantation. The mean follow-up was 621±291 days in CABG and 455±216 days in PCI. Survival, major adverse cardiac events (MACE), and target lesion revascularization (TLR) were analyzed by the Kaplan-Meier method. (Results) Preoperative characteristics and risk factors were compatible between the groups except for EuroSCORE (8.0±3.5 in CABG and 5.0±3.0 in PCI, p<0.0001). Thirty-day mortality was 3.5% (elective cases 0%) in CABG and 0% in PCI. Survival rate at 2 years was 94.2% in CABG and 90.2% in PCI (p=0.25). Survival rate at 2 years excluding emergent cases was 98.2% in CABG and 91.2% in PCI (p<0.05)(Figure ). MACE-free rate at 2 years was 93.5% in CABG and 59.7% in PCI (p<0.0001). Freedom from TLR was 98.0% in CABG and 58.8% in PCI (p<0.0001). During the follow-up period, there were 2 late deaths in CABG and 11 late deaths (including 5 sudden deaths) in PCI. (Conclusions) CABG was superior to PCI with DES in terms of long-term outcomes including survival, MACE-free, and TLR. DES carried higher risk for sudden death which might be associated with stent thrombosis. Survival curve in elective cases

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Sex difference among patients with unprotected left main coronary artery disease undergoing percutaneous coronary intervention in northern China

The Heart Surgery Forum ◽

10.1532/hsf.1810 ◽

2018 ◽

Vol 21 (4) ◽

pp. E322-E325 ◽

Cited By ~ 1

Author(s):

Yongxin Wang ◽

Zhiqiang Yang ◽

Yonggang Yuan ◽

Zesheng Xu

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Clinical Characteristics ◽

Left Main Coronary Artery ◽

Northern China ◽

Coronary Intervention ◽

Left Main ◽

Percutaneous Coronary ◽

Gender Specific

Background: Unprotected left main coronary artery (ULMCA) disease is associated with high mortality and morbidity. The aim of this study is to investigate the efficacy of percutaneous coronary intervention (PCI) on gender-specific patients with ULMCA in the Chinese population and provide a basis for further treatment of PCI in ULMCA disease. Methods: 173 patients (female, N = 52; male, N = 121; mean age = 61.02 ± 7.95) with ULMCA disease, who underwent PCI between January 2010 and December 2014, were investigated in our study. The mean follow-up time was 23.8 ± 7.3 months. The baseline clinical characteristics, coronary angiography (CAG) and PCI procedures, and in-hospital and follow-up outcomes of gender-specific patients were evaluated. Results: There were no statistically significant differences in baseline clinical characteristics with the exception of body weight, height, and smoking indexes between women and men. During PCI procedure, femoral artery puncture was more preferred in women than men (P < .05), whereas radial artery puncture was more preferred in men than women (P < .05). The characteristics of CAG and PCI procedures (except puncture path) were showed with no markedly difference between women and men. The incidences of MACCEs in male patients during the in-hospital and follow-up periods were slightly higher than those of the female patients although with no statistical differences. Conclusion: In northern China, the incidence of ULMCA disease in men is likely to be higher than in women, whereas PCI for ULMCA disease shows similarly favorable outcomes in women as well as in men. During the PCI procedure, femoral artery puncture in women and radial artery puncture in men are recommended.

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TCT-797 Ten years follow-up results of primary percutaneous coronary intervention in left main coronary artery disease

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.09.1007 ◽

2017 ◽

Vol 70 (18) ◽

pp. B324

Author(s):

Jesus Piqueras-Flores ◽

Ignacio Sanchez-Perez ◽

Fernando Lozano ◽

María Thiscal López Lluva ◽

Natalia Pinilla-Echeverri ◽

...

Keyword(s):

Coronary Artery Disease ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Left Main Coronary Artery ◽

Coronary Intervention ◽

Left Main ◽

Main Coronary Artery Disease ◽

Percutaneous Coronary ◽

Artery Disease

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Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention-Our Experiences at a Tertiary Hospital

Cardiovascular Journal ◽

10.3329/cardio.v6i2.18349 ◽

2014 ◽

Vol 6 (2) ◽

pp. 107-111

Author(s):

S Munwar ◽

AHMW Islam ◽

S Talukder ◽

AQM Reza ◽

T Ahmed ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Left Main Coronary Artery ◽

Coronary Intervention ◽

Drug Eluting Stent ◽

Bare Metal ◽

Coronary Artery Diseases ◽

Left Main ◽

Percutaneous Coronary ◽

Drug Eluting

Background: Aim of the study was to evaluate the primary procedural success of percutaneous coronary intervention of unprotected left main coronary artery stenosis using either Bare-metal stents or drug eluting stent. Methods: Total 33 patients were enrolled in this very preliminary non-randomized prospective cohort study. Among them, Male: 25 and Female: 8. Total 35 stents were deployed. Mean age were for Male: 59 yrs, for Female: 62 yrs. Associated coronary artery diseases risk factors were dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive family history for coronary artery diseases and smoking. Results: Among the study group; 26 (78%) were Dyslipidemic, 24(70%) were hypertensive; 17 (51.5%) patients were Diabetic, 11(33%) were smoker and 7(21%) patients had family history of Ischaemic heart disease. Female patients were more obese (BMI M 26: F 27) and developed coronary artery diseases in advance age. Common stented territory were left main: 20 (60%), Left main to left anterior descending artery 7 (22%) and Left main to left circumflex artery 6 (18%). Average length and diameter of stent was 3.5 and 18 mm respectively. Stent used: Bare Metal Stent 5 (15%), Drug Eluting Stent: 28 (85%). Among the different Drug Eluting Stents, Everolimus eluting stents were 11 (39.3%), Sirolimus eluting 10(35.7%), Paclitaxel eluting 3 (10.7%), Biolimus eluting 3 (10.7%) and Zotarolimus eluting1 (3.6%). In the present study, overall survival outcome was 94% (31 patient), mortality of cardiac cause 3% (1 patient) and 1 patient (3%) died of hepatocellular carcinoma. Conclusion: Our study has shown that percutaneous coronary intervention of the unprotected left main is a safe and effective alternative to Coronary Artery Bypass Graft (CABG). DOI: http://dx.doi.org/10.3329/cardio.v6i2.18349 Cardiovasc. j. 2014; 6(2): 107-111

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