Pooja M Vyas1, Jayesh S Prajapati2, Sibasis S Sahoo3, Iva Vipul Patel4, Jagjeet K Deshmukh1, Chirag Patel5, Roopesh Singhal5. 1. Assistant Professor, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India. 2. Head and Professor, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India. 3. Associate Professor, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India. 4. Research Assistant, Department of Research, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India. 5. Resident, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India.
Abstract
INTRODUCTION: Significant unprotected Left Main Coronary Artery (LMCA) disease is detected in 5%-7% of cases undergoing Coronary Angiography (CAG). Present guidelines have revealed the significance of anatomical location in left main artery stenosis and syntax scores for determination of Major Adverse Cardiac Events (MACE). Debate still persists over the best treatment regarding outcomes of Coronary Artery Bypass Grafting (CABG) and LMCA stenting for patients with LMCA disease. AIM: Aim of the study was to evaluate short and intermediate term clinical outcomes of Percutaneous Coronary Intervention (PCI) in LMCA disease in respect to mortality, Cerebrovascular Accidents (CVA), reinfarction, stent restenosis and need for repeat target lesion revascularization. MATERIALS AND METHODS: From July 2013 to February 2015, 50 patients underwent LMCA stenting. All patients underwent detailed clinical assessment, detailed 2D echocardiographic assessment. Syntax score was calculated in all patients. Clinical in hospital and outpatient follow up was obtained at one, three, six, nine months and one year. RESULTS: Mean age was 53.14±9.60 years. On CAG 16 (32%) patients had ostial LMCA lesion, 8 (16%) had mid LMCA lesion, distal LMCA was diseased in 6 (12%). In emergency situation, two bail out LMCA stenting were done for treatment of LMCA dissection. A total of 42 (84%) patients had low syntax score, 6 (12%) had intermediate and 2 (4%) had high syntax score. Only LMCA stenting was done in 22 (44%) patients, LMCA to Left Anterior Descending (LAD) stenting was done in 22 (44%) and LMCA to Left Circumflex (LCX) stenting was done in 6 (12%) patients. Drug-Eluting Stent (DES) was used in 35 (70%) cases while Bare-Metal Stent (BMS) was used in 15 (30%). An 8% mortality and 8% target lesion revascularization rate were observed in our study. CONCLUSION: Our study revealed that LMCA stenting is a safe and feasible alternative mode of revascularization in selected patients. Patients most suitable for LMCA stenting in our study were those with isolated ostial/mid LMCA disease, with protected LMCA disease and those who underwent elective stenting procedure.
INTRODUCTION: Significant unprotected Left Main Coronary Artery (LMCA) disease is detected in 5%-7% of cases undergoing Coronary Angiography (CAG). Present guidelines have revealed the significance of anatomical location in left main artery stenosis and syntax scores for determination of Major Adverse Cardiac Events (MACE). Debate still persists over the best treatment regarding outcomes of Coronary Artery Bypass Grafting (CABG) and LMCA stenting for patients with LMCA disease. AIM: Aim of the study was to evaluate short and intermediate term clinical outcomes of Percutaneous Coronary Intervention (PCI) in LMCA disease in respect to mortality, Cerebrovascular Accidents (CVA), reinfarction, stent restenosis and need for repeat target lesion revascularization. MATERIALS AND METHODS: From July 2013 to February 2015, 50 patients underwent LMCA stenting. All patients underwent detailed clinical assessment, detailed 2D echocardiographic assessment. Syntax score was calculated in all patients. Clinical in hospital and outpatient follow up was obtained at one, three, six, nine months and one year. RESULTS: Mean age was 53.14±9.60 years. On CAG 16 (32%) patients had ostial LMCA lesion, 8 (16%) had mid LMCA lesion, distal LMCA was diseased in 6 (12%). In emergency situation, two bail out LMCA stenting were done for treatment of LMCA dissection. A total of 42 (84%) patients had low syntax score, 6 (12%) had intermediate and 2 (4%) had high syntax score. Only LMCA stenting was done in 22 (44%) patients, LMCA to Left Anterior Descending (LAD) stenting was done in 22 (44%) and LMCA to Left Circumflex (LCX) stenting was done in 6 (12%) patients. Drug-Eluting Stent (DES) was used in 35 (70%) cases while Bare-Metal Stent (BMS) was used in 15 (30%). An 8% mortality and 8% target lesion revascularization rate were observed in our study. CONCLUSION: Our study revealed that LMCA stenting is a safe and feasible alternative mode of revascularization in selected patients. Patients most suitable for LMCA stenting in our study were those with isolated ostial/mid LMCA disease, with protected LMCA disease and those who underwent elective stenting procedure.
Entities:
Keywords:
Bail out LMCA stenting; Elective LMCA stenting; LMCA revascularization
Authors: Patrick W Serruys; Marie-Claude Morice; A Pieter Kappetein; Antonio Colombo; David R Holmes; Michael J Mack; Elisabeth Ståhle; Ted E Feldman; Marcel van den Brand; Eric J Bass; Nic Van Dyck; Katrin Leadley; Keith D Dawkins; Friedrich W Mohr Journal: N Engl J Med Date: 2009-02-18 Impact factor: 91.245
Authors: Tullio Palmerini; Diego Sangiorgi; Antonio Marzocchi; Corrado Tamburino; Imad Sheiban; Massimo Margheri; Giuseppe Vecchi; Giuseppe Sangiorgi; Michele Ruffini; Antonio L Bartorelli; Carlo Briguori; Luigi Vignali; Francesco Di Pede; Angelo Ramondo; Luigi Inglese; Marco De Carlo; Leonardo Bolognese; Alberto Benassi; Cataldo Palmieri; Vincenzo Filippone; Fabio Barlocco; Giulia Lauria; Stefano De Servi Journal: Eur Heart J Date: 2009-06-09 Impact factor: 29.983
Authors: S Yusuf; D Zucker; P Peduzzi; L D Fisher; T Takaro; J W Kennedy; K Davis; T Killip; E Passamani; R Norris Journal: Lancet Date: 1994-08-27 Impact factor: 79.321