Five-year outcomes after stenting of unprotected left main coronary artery stenosis in patients with normal left ventricular function

Lee, Bong Ki; Hong, Myeong‐Ki; Lee, Cheol Whan; Choi, Bong-Ryong; Kim, Mi-Jeong; Park, Kyoung-Ha; Kim, Young‐Hak; Han, Ki-Hoon; Kim, Jae‐Joong; Park, Seong-Wook; Park, Seung‐Jung

doi:10.1016/j.ijcard.2006.02.006

Cited by 21 publications

(20 citation statements)

References 26 publications

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“…7,34,35 Although PCI for ULMCA stenosis is considered as a class III indication in established guidelines regarding whether CABG is eligible for patients, emerging studies of revasculization for ULMCA stenosis achieved by implantation of DES or bare metal stent revealed promising both short-term and long-term outcomes. [34][35][36][37] Additionally, 3 recent non-randomized observation studies demonstrated lower 1-year mortality rates in patients undergoing PCI for ULMCA stenosis as compared to those receiving CABG. 4,38,39 However, TLR was higher in PCI group than in CABG group although TLR was not always clinicaldriven in the PCI group.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Transradial Stenting for Unprotected Left Main Coronary Artery Stenoses

Cheng

Fang

et al. 2007

Circ J

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s opposed to 1-or 2-vessel coronary artery diseases (CAD), patients with unprotected left main artery disease carry poor outcomes if left unrevascularized. 1,2 Percutaneous coronary intervention (PCI) is regarded as a potential alternative management of unprotected left main coronary artery (ULMCA) disease to coronary artery bypass graft surgery (CABG) in selected patients due to comparable short-term clinical results. [3][4][5] Given the high percentage of distal bifurcation lesions and the large vessel diameter in ULMCA disease, most PCI for ULMCA stenoses are performed via the transfemoral approach using either 7 or 8 French (Fr) guiding catheters. [6][7][8][9] With recent advances in PCI instruments and techniques, most coronary lesions can now be safely treated via the transradial approach with a high procedural success rate and relatively few local vascular complications. 10,11 Nevertheless, the literature review reveals few case reports regarding transraCirculation Journal Vol.71, June 2007 dial stenting for ULMCA disease and only one small-scale study comparing the transradial and the transfemoral approach for both protected and unprotected left main PCI. [12][13][14][15] Thus, the feasibility and safety of routine transradial stenting for ULMCA stenoses remains unclear. To elucidate the feasibility and safety of this procedure, we retrospectively reviewed the success rate, in-hospital complications and 1-year outcomes of patients undergoing transradial coronary stenting for ULMCA stenoses in our medical facility. Methods Study Population and ProceduresAll patients undergoing elective coronary stent implantation in Chang Gung Memorial Hospital -Kaohsiung Medical Center, between June 2001 and August 2006, for ULMCA diseases with diameter stenosis ≥50% were selected for retrospective analysis. Patients presenting with ST-segment elevation acute myocardial infarction (MI) were excluded from the present study. Instead of surgery, PCI was chosen when suitable anatomy for stenting via a percutaneous approach was present and CABG was considered high risk owing to the presence of either old age or comorbidity, or in cases involving simple patient preference, which was defined as CABG eligibility. The unilateral radial artery was punctured routinely for the initial coronary angiogram at our institute unless patients had positive Allen's test, weak radial artery pulsation, wrist joint deformity or a local wound unsuitable for this approach. If the puncture of bilateral radial arteries failed, either the Circ J 2007; 71: 855 -861 (Received November 28, 2006; revised manuscript received February 13, 2007; accepted March 7, 2007) Feasibility and Safety of Transradial Stenting for Unprotected Left Main Coronary Artery StenosesCheng-I Cheng, MD* , **; Chiung-Jen Wu, MD**; Chih-Yuan Fang, MD**; Ali A. Youssef, MD**; Chien-Jen Chen, MD**; Shyh-Ming Chen, MD**; Cheng-Hsu Yang, MD**; Shu-Kai Hsueh, MD**; Hon-Kan Yip, MD**; Mien-Cheng Chen, MD**; Morgan Fu, MD**; Yuan-Kai Hsieh, MD** Background Percutaneous corona...

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Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Transradial Stenting for Unprotected Left Main Coronary Artery Stenoses

Cheng

Fang

et al. 2007

Circ J

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“…28) Lee, et al reported a cumulative incidence of TVR after 1 and 3 years of 18.8% and 20.7%, respectively. 29) In the present study, SES was still associated with a relatively high TVR rate of 19.0%. Notably, the high rate of TVR was also driven by a comparatively high rate of angiographic follow-up.…”

Section: Discussionmentioning

confidence: 39%

Long-Term (4-Year) Outcomes and Predictors of Adverse Cardiac Events After Sirolimus-Eluting Stent Implantation in Unprotected Left Main Coronary Artery

Wu¹,

Chen

Kubo

et al. 2010

Int. Heart J.

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SummaryThe long-term safety and efficiency of sirolimus-eluting stent (SES) treatment in unprotected left main coronary artery (ULMCA) have not yet been ascertained.From 2003 to 2006, 126 consecutive patients with de novo lesions in ULMCA who underwent SES were retrospectively analyzed in a single center in China. During 4-year follow-up, major adverse cardiovascular event (MACE)-free survival was 74.6%. Cardiac death occurred in 5 (4.0%), and target lesion revascularization (TLR) and target vessel revascularization (TVR) occurred in 15 (11.9%) and 24 (19.0%) patients, respectively. One (0.8%) experienced probable stent thrombosis while 1 (0.8%) presented possible stent thrombosis. Impaired LVEF (< 40%) and high surgical risk (Euro score > 6) were the independent predictors of MACEs.PCI with SES for de novo lesions in ULMCA is feasible with a low procedural risk. However, SES was associated with a relatively higher rate of TLR and TVR. Impaired LVEF and high surgical risk were important predictors of MACEs. (Int Heart J 2010; 51: 377-382) Key words: Angioplasty, Left main coronary artery stenosis, Sirolimus-eluting stents L eft main stenosis occurs in 4% to 6% of all patients undergoing coronary angiography. 1,2) Preliminary trial results confirmed that implantation of a drug-eluting stent (DES) to treat unprotected left main coronary artery (UL-MCA) disease is feasible and relatively safe in appropriately selected patients.3-9) However, in-stent restenosis and the risk of late thrombosis limit the widespread application of DES, especially because of the potential risk of sudden death associated with ULMCA restenosis. The aim of the present study was to evaluate the long-term clinical outcomes and identify associated predictors for major adverse cardiac events (MACEs) in patients undergoing elective intervention with sirolimus-eluting stents (SES) for ULMCA lesions in a "real-world" setting at a single center in China. ULMCA stenosis who underwent elective PCI with SES were enrolled in this study. Patients presenting with ST-segment elevation myocardial infarction or cardiogenic shock were excluded. All patients provided written informed consent, and the local ethics committee approved the use of clinical data for this study. MethodsThe decision to perform PCI rather than CABG was dependent on either physician or patient preference. Thirty-nine (31%) patients treated with PCI were considered high risk for CABG with a Euroscore > 6 or Parsonnet score > 15. 10,11) Procedural characteristics: All interventions were performed according to concurrent practice guidelines. 12,13) Bifurcation lesions were treated using one of 4 stenting strategies at the discretion of the operator: Crossover, T stent, Culotte stent, or the Crush technique.14,15) Final kissing balloon dilation was mandatory in cases with suboptimal results at the branch ostium. The choice of a particular SES and antithrombotic agent utilized was made by the operator. Overall, 126 patients received SESs including Cypher (Johnson & Johnson, Cordis, Mia...

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“…This finally may result in the lower restenosis rate [18]. The current clinical guidelines recommend the use of antiproliferative drug eluting stents [19][20][21][22]. …”

Section: Discussionmentioning

confidence: 99%

Chronic Total Occlusion of the Left Main Coronary Artery in a 63-Year- Old Woman after Triple Coronary Bypass Surgery

Zajdel¹,

Andres²,

Durak³

2016

J Clin Exp Cardiolog

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Five-year outcomes after stenting of unprotected left main coronary artery stenosis in patients with normal left ventricular function

Cited by 21 publications

References 26 publications

Feasibility and Safety of Transradial Stenting for Unprotected Left Main Coronary Artery Stenoses

Feasibility and Safety of Transradial Stenting for Unprotected Left Main Coronary Artery Stenoses

Long-Term (4-Year) Outcomes and Predictors of Adverse Cardiac Events After Sirolimus-Eluting Stent Implantation in Unprotected Left Main Coronary Artery

Chronic Total Occlusion of the Left Main Coronary Artery in a 63-Year- Old Woman after Triple Coronary Bypass Surgery

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