Abstract
Background: Significant lesions in the left main coronary artery are found in approximately 5% of patients undergoing coronary angiography, with most cases involving multiple vessels and affecting the distal bifurcation. A coronary artery bypass graft surgery is considered the preferred treatment for unprotected left main coronary artery lesions. However, with the advancement of techniques and the introduction of new drug-eluting stents, percutaneous coronary intervention has been considered a viable strategy, with favorable results. The objective of this study was to analyze the outcomes in patients with unprotected left main coronary artery lesions undergoing percutaneous coronary intervention. Methods: Electronic data from patients undergoing percutaneous coronary intervention between December 2017 and January 2020 at a single center were analyzed to assess clinical and angiographic characteristics and clinical outcomes. Results: A total of 103 patients with significant unprotected left main coronary artery lesions were included; in that, 66% were male, 88.3% were hypertensive, and 87.4% had normal ventricular function. Lesions involving the bifurcation were identified in 73.8% of patients, 36.9% had concomitant lesions in the three major epicardial vessels, and 42.7% had an intermediate SYNTAX score (23 to 32 points). Angiographic success was achieved in 100% of cases, with four (3.9%) adverse cardiac and cerebrovascular events, with 2.9% mortality. Conclusion: Hospital results support percutaneous coronary intervention as a safe procedure, with excellent angiographic results and low rates of adverse cardiac and cerebrovascular events. We concluded that PCI is an option to coronary artery bypass graft surgery and is a very viable option for surgical treatment of unprotected left main coronary artery lesions.
Highlights
Left main coronary artery (LMCA) lesions are always relevant, due to the risk of serious clinical repercussions due to the large myocardial area involved
Angiographic success was defined as a successful stent implantation, with
The present study reports the experience in the treatment of unprotected LMCA lesions by percutaneous coronary intervention (PCI) performed in a single cardiology center
Summary
Left main coronary artery (LMCA) lesions are always relevant, due to the risk of serious clinical repercussions due to the large myocardial area involved. They are con sidered severe when the obstruction is greater than 50% of the coronary lumen or the angiographic appearance indicates a high probability of acute occlusion (dissection, ulcer, or thrombus). Left main coronary artery is classified as protected when the patient has a patent bypass graft to the left circumflex artery or to the left anterior descending artery.[1]. Coronary artery bypass grafting (CABG) has always been the preferred treatment for unprotected LMCA lesions, and considered superior to an optimized drug treatment.[3,4]. Coronary artery bypass grafting (CABG) has always been the preferred treatment for unprotected LMCA lesions, and considered superior to an optimized drug treatment.[3,4] Up until recently, percutaneous coronary intervention (PCI) was not considered as a treatment option, due to technical difficulties, the high prevalence of associated lesions in other coronary vessels, and the high risk of restenosis, which can lead to catastrophic outcomes.[4]
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