Long-Term Clinical Outcomes After Unprotected Left Main Trunk Percutaneous Revascularization in 279 Patients

Abstract

for the ULTIMA Investigators* Background-Percutaneous coronary revascularization (PCI) has been increasingly applied to unprotected left main trunk (LMT) lesions, with varied long-term success. This study attempts to define the predictors of outcome in this population. Methods and Results-Two hundred seventy-nine consecutive patients who had LMT PCI at 1 of 25 sites between 1993 and 1998 were studied. Forty-six percent of these patients were deemed inoperable or at high surgical risk. Thirty-eight patients (13.7%) died in hospital, and the rest were followed up for a mean of 19 months. The 1-year incidence was 24.2% for all-cause mortality, 20.2% for cardiac mortality, 9.8% for myocardial infarction, and 9.4% for CABG. Independent correlates of all-cause mortality were left ventricular ejection fraction Յ30%, mitral regurgitation grade 3 or 4, presentation with myocardial infarction and shock, creatinine Ն2.0 mg/dL, and severe lesion calcification. For the 32% of patients Ͻ65 years old with left ventricular ejection fraction Ͼ30% and without shock, the prevalence of these adverse risk factors was low. No periprocedural deaths were observed in this low-risk subset, and the 1-year mortality was only 3.4%. Conclusions-Patients undergoing unprotected LMT PCI have frequent serious comorbidities and consequently have high event rates. PCI may be an alternative to CABG for a select proportion of elective patients and may also be appropriate for highly symptomatic inoperable patients. Meticulous follow-up of hospital survivors is required because of the rather high mortality during the first few months after treatment.

Multislice Spiral Computed Tomography for the Evaluation of Stent Patency After Left Main Coronary Artery Stenting

“…Until recently, more widespread applicability of this revascularization modality had been hampered by the high occurrence of ISR. 9,18,19 The advent of the DES has both significantly reduced restenosis rates and improved long-term clinical outcome; this has already resulted in an increasing proportion of patients with LM disease being treated percutaneously. 6,7 However, restenosis still occurs and when located in the LMCA may cause severe myocardial ischemia with potentially fatal consequences.…”

“…6,7 However, restenosis still occurs and when located in the LMCA may cause severe myocardial ischemia with potentially fatal consequences. 19,20 A noninvasive method for its detection, before clinical events occur, would be of major clinical value. The results of the present study indicate that current MSCT scanners may provide a reliable alternative to CCA.…”

Percutaneous coronary intervention in unprotected left main stem disease: the state of play

“…7 By contrast, the one year mortality for the high risk group in ULTIMA was 24.2%. 8 Similarly, Takagi et al reported outcome in 67 consecutive patients undergoing PCI to unprotected LMS and found the overall cardiac survival at three years to be 91% (although there were three other non-cardiac deaths). 9 The subgroup of patients with a Parsonnet score of .…”

Inflammatory Biomarkers for Prediction of Outcomes After Unprotected Left Main Coronary Intervention

“…The recent Unprotected Left Main Trunk Investigation Multicenter Assessment (ULTIMA) registry report involved 279 patients, 46% of whom were deemed inoperable or at high surgical risk. 3 For the latter patients, the in-hospital mortality rate was 14%, whereas the 1-year incidence rates were 24.2% for all-cause mortality, 20.2% for cardiac mortality, and 9.8% for myocardial infarction (MI). In that study, decreasing left ventricular function (Ͻ30%) was inversely related to events.…”