Long-term Follow-up After Percutaneous Treatment of the Unprotected Left Main Stenosis in High Risk Patients Not Suitable for Bypass Surgery

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• 作者：Joan Antoni Gó ; mez-Hospital^a ; ^{26587jgh@comb.cat} ; Josep Gomez-Lara^a ; Juan Rondan^b ; Silvia Homs^a ; Iñ ; igo Lozano Martí ; nez-Luengas^b ; Jose Luí ; s Ferreiro^a ; Gerard Roura^a ; Jaume Maristany^a ; Luis Teruel^a ; Amelia Carro^b ; Pablo Avanzas^b ; Paco Jara^a ; Enric Esplugas^a ; Cesar Moris^b ; Angel Cequier^a
• 关键词：CABG ; coronary artery bypass graft ; IVUS ; intravenous ultrasound ; MACE ; major adverse cardiac events ; PCI ; percutaneous coronary intervention ; TLR ; target lesion revascularization ; ULM ; unprotected left main
• 刊名：Revista Españ ; ola de Cardiologí ; a (English Edition)
• 出版年：2012
• 期刊代码：277_18855857
• 类别：med
• 出版时间：June, 2012
• 卷：65
• 期：6
• 页码：530-537
• 文件大小：377 K

摘要

Introduction and objectives

Percutaneous coronary intervention is recommended in patients with unprotected left main stenosis non suitable for coronary artery bypass graft. Long-term follow-up of those patients remains uncertain.

Methods

All patients with de novo unprotected left main stenosis treated with stent implantation were consecutively enrolled. Percutaneous coronary intervention was indicated according to the standards of care, taking into account clinical and anatomical conditions unfavorable for coronary artery bypass graft. The primary end point was the occurrence of major adverse cardiac events, a composite of death, nonfatal acute myocardial infarction, or target lesion revascularization.

Results

Of 226 consecutive patients included, 202 (89.4%) were treated with drug-eluting stents. Mean age was 72.1 years, 41.1%had renal dysfunction, and mean Syntax score and EuroSCORE were 28.9 and 7.4, respectively. Angiographic and procedural success was achieved in 99.6%and 92.9%of patients. At 3.0 years, the rates of major adverse cardiac events, death, nonfatal acute myocardial infarction and target lesion revascularization were 36.2%, 25.2%, 8.4%, 8.0%, respectively. Target lesion revascularization was more frequently observed when 鈮? stents were implanted rather than a single stent (18.5%vs 5.8%, P=.03); and with bare metal stents rather than drug-eluting stents (13.0%vs 7.9%, P=.24). Definite stent thrombosis was observed in 2 patients (0.9%) and probable stent thrombosis in 7 (3.1%). Female sex, impaired left ventricular function, and use of bare metal stents were significantly related with all-cause mortality.

Conclusions

High-risk patients with unprotected left main stenosis treated with percutaneous coronary intervention presented with a high rate of major adverse cardiac events at long-term follow-up. Female sex, impaired left ventricular function, and use of bare metal stents were predictors of poor prognosis.