Aim: Percutaneous coronary intervention (PCI) of left main (LM) coronary artery stenosis may become an alternative to the standard therapy, coronary artery bypass graft surgery (CABG). The purpose of the present study was to describe the outcome after LM PCI in three cohorts of patients: patients with low surgical risk, patients with high surgical risk or patients considered inoperable, and patients with acute ST elevation MI.
Methods and results: 104 consecutive patients who had LM PCI at the Department of Cardiology, Skejby University hospital between 1999 and 2004 were investigated. The patients were divided into three groups according to PCI indication and operability: surgical low risk patients and suitable lesions for PCI (n=27), poor CABG candidates (age > 80 years, severe comorbidity or inoperability) (n=50), and patients presenting with AMI (n=27). In the three groups mean ages±SD were: 60±14, 76±9, and 68±12 years, respectively. At thirty days follow-up the cumulative incidence of major adverse cardiac events (MACE); cardiac death, MI, or target lesion revascularization (95% CI) were 4 (1-24)%, 16 (8-30)%, and 41 (25-61)%, respectively. At 6 months the cumulative incidence of MACE were 4 (1-24)%, 27 (17-43)%, and 41 (25-62)%.
Conclusions: PCI of LM coronary artery stenosis can be performed with good outcome in patients with low surgical risk and with acceptable outcome in surgical high risk patients or patients considered inoperable. Patients with AMI and culprit lesion in the LM have a high mortality in the acute phase, but mid-term prognosis is good if the patient is successfully treated with PCI. This follow-up study underlines the importance of risk stratification in the heterogeneous group of patients undergoing LM PCI.
Percutaneous coronary intervention (PCI) of unprotected left main (LM) coronary artery stenosis may become an alternative to coronary artery bypass graft surgery (CABG) in selected patients for various reasons: It may be performed as an emergency procedure in patients with acute myocardial infarction (AMI) and cardiogenic shock. It is a treatment option in patients with a high surgical risk or patients considered inoperable, and it can be performed in surgically low risk patients where the LM lesion has suitable anatomy for stenting. Before PCI is considered an alternative to CABG, an acceptable PCI outcome must be documented. In surgically low risk patients only a low mortality and cardiac event rate can be accepted, while a higher level of adverse events may be accepted in a higher surgical-risk subset of patients or in patients considered inoperable. The purpose of the present study was to describe the outcome in three cohorts of patients: patients with low surgical risk (group 1), poor CABG candidates (group 2), and patients with ST elevation AMI (group 3).