Abstract
Critical stenosis of left main coronary artery (LMCA) has always remained a challenge for interventional cardiologists. Conventionally Coronary Artery Bypass Grafting (CABG) is done for these patients but recently Percutaneous Coronary Intervention (PCI) is also being tried more frequently, but data of PCI is scarce in this regard. Our objective was to determine the safety and technical success rate of percutaneous left main coronary artery stenting. This was 12 month follow up study conducted at Pakistan Institute of Medical Sciences (PIMS), Islamabad from 11(th) Jan 2012 to 11(th) Jan 2013. All symptomatic patients who underwent coronary angiogram at PIMS and were found to have either isolated LMCA disease or coexisting osteal Left Anterior Descending (LAD) artery disease were potentially eligible for the study. Patients who had previous surgical treatment for coronary artery disease and those with renal dysfunction requiring dialysis were excluded. Patients were counselled in detail regarding the pros and cons of PCI versus CABG.Those who opted for PCI were included in the study. All these patients were treated with percutaneous left main coronary artery stenting with or without osteal LAD stenting. Seventy two patients had LMCA disease during angiogram. Fifteen patients opted for CABG. Four patients did not meet the inclusion criteria, whereas 53 patients were finally enrolled. Mean age of patients were 55.45±10.275 years. Twenty nine patients were with acute coronary syndrome and 22 presented with unstable angina.PCI with stenting was technically successful in all patients. One patient died three months after PCI, there was no other mortality. Our study showed that Percutaneous Coronary Intervention (PCI) to LMS has good technical success rate; the safety of the procedure is also acceptable.
Highlights
Significant left main coronary artery (LMCA) disease has been found in 3% to 5% of all patients who undergo coronary angiography and in 10%Correspondence: December 20, 2013 January 7, 2014 April 17, 2014 May 12, 2014 to 30% of patients who undergo bypass surgery.[1,2,3,4] Critical LMCA stenosis puts patients at high risk of cardiovascular events because of the extent of jeopardized myocardium and associated multivessel coronary artery disease and, it has been considered as the most important coronary lesion in terms of prognosis
The introduction of coronary stenting has led to a reassessment of the role of Percutaneous Coronary Intervention (PCI) as a practical treatment option for LMCA disease,[14,15,16,17] and the widespread availability of drug-eluting stents (DES), together with enhanced stenting techniques, has lowered the threshold for use of PCI, instead of coronary artery bypass grafting (CABG), in patients with LMCA disease.[18]
Data Collection Procedure: All patients who have history of coronary artery disease or who presented with acute coronary syndrome and were found to have either isolated LMCA disease or Osteal Left Anterior Descending (LAD) disease along with LMCA were potentially eligible for enrollment
Summary
Correspondence: December 20, 2013 January 7, 2014 April 17, 2014 May 12, 2014 to 30% of patients who undergo bypass surgery.[1,2,3,4] Critical LMCA stenosis puts patients at high risk of cardiovascular events because of the extent of jeopardized myocardium and associated multivessel coronary artery disease and, it has been considered as the most important coronary lesion in terms of prognosis. Current practice guidelines suggest coronary artery bypass grafting (CABG) as the standard procedure for patients with unprotected LMCA disease[5,6,7] primarily because long-term outcomes of surgical revascularization are superior to those of medical treatment.[8,9,10] because of anatomic accessibility and other characteristics, percutaneous coronary intervention (PCI) for LMCA disease was attractive to the interventional cardiologist, and data from several archives showed its feasibility and short and midterm effectiveness. We have reviewed recent advances and the current status of percutaneous versus surgical treatment for LMCA disease, focusing on whether PCI is an alternative to or a possible replacement for CABG in these patients.[20]
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