Unprotected left main angioplasty in Stent Era. In-hospital and long term outcome

pp 627-634

Abstract

Objectives The purpose of the present study is to analyzed acute and long term outcome of patients with unprotected left main stenosis treated with stents . Material and method From March 1995 to July 1998 forty two patients with unprotected left main were treated with stents . The indications for stenting were emergent in 11 patients and elective in 31 patients . Six patients were defined as poor surgical candidate . Refractory unstable angina or acute myocardial infarction were present in 95% of the patients . Isolated left main was observed in 9 patients . In the remains we also treated in the same procedure the left anterior descending in 30 patients. Left circumflex in 4 patients and the right coronary artery in 6 patients . Abciximab in bolus and infusions was used in 43% of the population . Ticlopidine orally was given during one month . A thallium stress test was required after the procedure at 1, 3, 4, 6, 9 and 12 months. Results Procedural and clinical success was obtained in all patients. We had no in-hospital death, emergent by pass surgery, vessel reocclusion of re-infarction . One patient treated after cardiac arrest developed major stroke. In the long term clinical follow up (> 30 to 1140 days) survival was 88% . Five patients died during follow up (12%) . Mortality was related to elective by pass surgery in 2 patients, mesenteric infarction in one patient, hemorrhagic stroke in one patient and whereas the last patient died in myocardial insufficiency 18 months after the procedure (poor surgical candidate) . Target lesions revascularization after hospital discharge was required in 19% (8/42) of the patients and were treated with new angioplasty in 5 and elective surgery in 3 . Conclusions Unprotected left main stenting in this high risk group of patients had 100% of procedural success, low in-hospital major complications and good long term survival.