Angioplasty of the left main coronary artery: Mid-term follow-up at University Medical Centre Groningen

Abstract

Background: Coronary angioplasty is being increasingly performed in complex lesions of the unprotected and protected left main (LM) coronary artery.

Objectives: To assess the impact of patient and operator related clinical variables of success and to evaluate the subsequent mid-term effects of percutaneous treatment of LM coronary stenosis.

Methods: In a tertiary referral, high-volume angioplasty centre a total of 118 consecutive surgical and nonsurgical patients with protected and unprotected LM lesions were treated and evaluated in a retrospective observational study.

Results: There were 57 protected and 61 unprotected patients, including 13 patients with an acute myocardial infarction (AMI). Mean age was 67 years (range 33-90). The length of the stenotic segment was 4.8±2.3 mm, mean lumen diameter 1.1±0.6 mm and percentage diameter stenosis 63.6±14.6%. There were seven (5.9%) in-hospital cardiac deaths which presented with AMI and cardiogenic shock. All seven patients had unprotected LM lesions. Average follow-up was eight months (range 1 to 36 months). Major adverse cardiac events (MACE) during follow-up comprised eight (6.8%) cardiac deaths, three (2.5%) myocardial infarctions, eight (6.8%) subjects with coronary bypass surgery and 16 (13.6%) repeated angioplasties. The total event rate (MACE, n=43) at the end of the follow-up period was 36.4%. There were more MACE in the unprotected group than in the protected group (41 vs. 31.6%, p<0.05).

Conclusion: This study supports prior data on LM angioplasty. LM stenting in AMI, however, showed less favourable in-hospital and late outcome.

Keywords: acute myocardial infarction; clinical outcome; left main angioplasty.