• Coronary Artery Disease
• Cardiology Clinical Trials
• Interventional Techniques & Devices

• Coronary Artery Disease
• Cardiology Clinical Trials
• Cardiology & Cardiovascular Medicine
• Interventional Techniques & Devices

Approximately 7% of patients who undergo cardiac angiography have left main coronary disease (LMCD). Guidelines as recent as 2012 have recommended surgical revascularization or coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) [Patel MR et al. J Am Coll Cardiol 2012]. Some studies evaluating elective PCI with drug-eluting stent (DES) implantation as compared to CABG in unprotected left main coronary artery (LMCA) lesions, however, have reported short- and midterm outcomes that are similar [Chieffo A et al. JACC Cardiovasc Interv 2010; Lee MS et al. J Am Coll Cardiol 2006].

Antonio Vellegas, MD, Medicina Cardiovascular Asociada, Santo Domingo, Dominican Republic, presented the results of a study that evaluated clinical and demographic characteristics and the outcomes of unprotected LMCA stenting. This was a retrospective, observational case series of 49 patients selected from the Interventional Cardiovascular Department database who received PCI between 2009 and 2013. Outcomes included in-hospital complications, cardiovascular deaths, total deaths, and total days of admission.

The majority of patients were men (69%) with a mean age of 70.3 ± 3.9 years and a body mass index (BMI) of 26.9 ± 11.1 kg/m². Participants were 85% Hispanic and 15% Caucasian. Most patients (86%) presented with hypertension. Diabetes mellitus was seen in 37% of patients, hypercholesterolemia in 27%, and chronic kidney disease in 6%; 16% were smokers. The following diagnoses were made at admission: stable coronary disease (n = 19), unstable angina (n = 16), myocardial infarction (n = 10), heart failure (n = 3), and cardiogenic shock (n = 1). Radial or femoral vascular access was obtained in all cases. Angiographic assessment denoted isolated left main (LM) disease (11 patients), LM disease plus singlevessel coronary vessel disease (11 patients), and LM disease plus 2 diseased coronary vessels (27 patients). In 81.7% (n = 40) of patients, intravascular ultrasound was used to guide placement of bare metal (n = 2) and sirolimus- (n = 3), everolimus- (n = 21), and/or zotarolimus (n = 23) eluting stents.

The mean days of in-hospital observation following PCI was 3.3 ± 2.2 (range, 2 to 7 days). Few patients (6%) experienced in-hospital complications. Major bleeding from the access site, coronary artery dissection and abrupt vessel closure, and coronary artery dissection/abrupt vessel closure/acute kidney failure/death was noted in 1 patient for each event.

Dr. Villegas noted that this was a retrospective case series with only in-hospital follow-up. In this series, stenting of unprotected LMCA was associated with a high procedural success and low in-hospital complication rate. He stressed that patient selection for both techniques is fundamental to success and directly affects clinical outcomes.

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