Results and prognostic factors associated with percutaneous coronary interventions for unprotected left main coronary artery disease

K Ben Brahim,A Meddeb,M Slim,O Labidi,H Ghardallou,A Romdhane,S Ben Farhat,S Ouanes,A Lagren,R Gribaa,I Neffati,E Boughzela

doi:10.1016/j.acvdsp.2019.09.041

K Ben Brahim, A Meddeb + Show 10 more

Open Access

https://doi.org/10.1016/j.acvdsp.2019.09.041

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Abstract

Unprotected left main coronary artery (ULMCA) disease is seen approximately 4% of patients who undergo angiography. Percutaneous coronary intervention (PCI) is an accepted alternative to surgery for the treatment of this disease. Aim of our study is to evaluate the results of our experience in ULMCA PCI and assess prognostic factors associated with such procedures. Between January 2005 and August 2016, 109 consecutive procedures of LMCA PCI were assigned retrospectively. Clinical variables, the reasons for cardiac catheterization, therapeutic decisions and clinical evolution in long-term follow-up were analyzed. The mean age of our population was 62.27 ± 10.68 years and predominantly male (72%). Diabetes mellitus was found in 63 patients (58%). Presentation on admission was mainly stable angina in 40 patients (37%). True bifurcation lesions (Medina 1-1-1 and 1-0-1) were present in 56 distal LMCA patients (51%). Triple vessel disease was associated in 21 patients (19%). The Syntax score was < 32 in 83%. The procedure was elective in 86% ( n = 93). Drug eluting stents were used in 84%. For distal LMCA, PCI technique was provisional T stenting in 90%. Angiographic success was achieved in 92% and procedural success in 90%. The in-hospital mortality rate was 4.5% ( n = 5). After a mean follow up of 39.7 ± 26.8 months, the rate of MACE was 29% (cardiac death: 5.7%, myocardial infarction: 10.57%, TLR: 12.5%). The rate of acute stent thrombosis was 0.9% ( n = 1). The syntax score, urgent PCI and distal ULMCA PCI was significantly associated with MACE ( P = 0.04, P = 0.036, P = 0.006 respectively). Diabetes mellitus and the bare metal stents were the only two independent factors associated significantly with TLR ( P = 0.03 and P = 0.04 respectively). The results of our growing experience in LMCA PCI are encouraging with high rate of procedural success and acceptable medium and long-term results.

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