Short, midterm and late results of percutaneous coronary interventions for left main coronary artery disease

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Published Jan 11, 2016
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Vol. 93 No. 11 (2015): Issue Nov 2015

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Rym Gribaa
Mehdi Slim
Kacem Slim
Helmi Ben Salem
Elyes Neffati
Sana Ouali
Fehmi Remadi
Essia Boughzela

Abstract

SUMMARY
Background: Left main coronary artery disease is found in 4-6% of patients undergoing diagnostic coronary angiography. Coronary artery bypass graft is the gold standard. However, percutaneous coronary intervention is a continuously evolving substitution for surgery in such patients.
Methods: We report a retrospective study of 32 patients with relevant left main coronary artery disease treated by angioplasty in our faculty, between January 2005 and March 2011.
Results: The mean age of the population on the study was 59.7±10.9 years. The sex-ratio was 3.57. The rate of angiographic success was 97%. The in-hospital stay was uneventful in 94%¨of our patients. Only one patient died of cardiogenic shock complicating an acute anterior myocardial infarction. After a mean follow up of 18.5 ± 15.4 months, the in-stent restenosis rate was 16.12%. The rate of major adverse cardiac events (MACE) was 29%. Independent predictive factors of
MACE were: cardiogenic shock on admission (p=0.022), emergency procedures (p=0.033), Euroscore > 6 (p=0.001), Parsonnet score > 20 (p=0.036), High C réactive protein levels on admission (p=0.007), creatinine level (p=0.008), left main citationsRaw diameter < 3.5 mm (p=0.036) and the use of bare metal stents (p=0.036). Independent predictive factors of in-stent restenosis were: use of bare metal stents (p=0.004) and Paclitaxel drug eluting stents (p=0.037).
Conclusion: Percutaneous coronary intervention is safe and a validated alternative to coronary artery bypass graft for left main coronary artery disease. However, it should be reserved to selected patients and limited to experienced centers.

Keywords:

Left main coronary artery disease, treatment, percutaneous coronary intervention

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