51
|
Abstract
Significant unprotected left main stem (ULMS) disease is in approximately 5% to 7% of patients undergoing coronary angiography. Historically, coronary artery bypass grafting has been the gold standard treatment of these patients. With recent advances in stent technology, adjunctive pharmacotherapy, and operator experience, percutaneous coronary intervention (PCI) is increasingly regarded as a viable alternative treatment option, especially in patients with favorable coronary anatomy (low and intermediate SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) scores). This article aims to discuss the evidence supporting PCI for ULMS disease, current guidelines, and technical aspects.
Collapse
Affiliation(s)
- Neil Ruparelia
- Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; Department of Cardiology Imperial College, Du Cane Road, London W12 0HS, UK
| | - Alaide Chieffo
- Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
| |
Collapse
|
52
|
Campos CM, Christiansen EH, Stone GW, Serruys PW. The EXCEL and NOBLE trials: similarities, contrasts and future perspectives for left main revascularisation. EUROINTERVENTION 2016; 11 Suppl V:V115-9. [PMID: 25983143 DOI: 10.4244/eijv11sva26] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Unprotected left main coronary artery (ULMCA) stenosis has relatively high prevalence and exposes patients to a high risk for adverse cardiovascular events. The optimal revascularisation strategy (coronary artery bypass surgery [CABG] or percutaneous coronary intervention [PCI]) for patients with complex coronary artery disease is a topic of continuing debate. The introduction of the newer-generation drug-eluting stents (DES) -with documented improvements in both safety and efficacy- has prompted the interventional community to design two new dedicated randomised trials comparing CABG and PCI: the NOBLE (Coronary Artery Bypass Grafting Vs Drug Eluting Stent Percutaneous Coronary Angioplasty in the Treatment of Unprotected Left Main Stenosis) and EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials. The aims of the present review are to describe the similarities and contrasts between these two trials as well to explore their future implications in ULMCA treatment.
Collapse
Affiliation(s)
- Carlos M Campos
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | |
Collapse
|
53
|
Li J, Patel SM, Parikh MA, Parikh SA. Unprotected Left Main Disease: Indications and Optimal Strategies for Percutaneous Intervention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:19. [PMID: 26874707 DOI: 10.1007/s11936-016-0441-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OPINION STATEMENT Although the incidence of left main (LM) coronary artery disease is relatively low in patients undergoing routine angiography, it is a common presentation in patients with acute coronary syndromes. With the current interventional tools and techniques, percutaneous intervention for LM disease has become a viable alternative to the traditional coronary artery bypass grafting. Factors that contribute to the success and appropriateness of percutaneous intervention for LM disease include coronary anatomy and patient-specific factors such as left ventricular function. Multiple considerations should be taken into account prior to intervention, including hemodynamic support if necessary, intravascular imaging to guide therapy, and stent technique. This review provides an overview of the current body of literature to support the use of percutaneous intervention in LM disease and serves as guideline for the interventionalist approaching LM revascularization.
Collapse
Affiliation(s)
- Jun Li
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Sandeep M Patel
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Manish A Parikh
- Center for Interventional Vascular Therapy, Division of Cardiology, NY Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Sahil A Parikh
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| |
Collapse
|
54
|
Percutaneous Transcatheter Assessment of the Left Main Coronary Artery. JACC Cardiovasc Interv 2015; 8:1529-39. [DOI: 10.1016/j.jcin.2015.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/14/2015] [Accepted: 07/17/2015] [Indexed: 11/24/2022]
|
55
|
Lavi S, Yadegari A. Left main coronary artery percutaneous coronary intervention in high-risk patients: hopes for improvement and limitations of randomized trials. Can J Cardiol 2014; 30:1256-8. [PMID: 25442428 DOI: 10.1016/j.cjca.2014.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 07/11/2014] [Accepted: 07/11/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shahar Lavi
- London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Andrew Yadegari
- London Health Sciences Centre, Western University, London, Ontario, Canada
| |
Collapse
|
56
|
Ragosta M. Left main coronary artery disease: importance, diagnosis, assessment, and management. Curr Probl Cardiol 2014; 40:93-126. [PMID: 25765453 DOI: 10.1016/j.cpcardiol.2014.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Left main coronary disease is seen in 4%-6% of patients undergoing coronary angiography for an ischemic evaluation and is a potentially fatal condition if not promptly identified and treated. Recent studies have increased our understanding of the complexity of left main coronary artery disease. This lesion subset offers numerous challenges in diagnosis and management. Fractional flow reserve and intravascular ultrasound are important adjuncts to angiography to determine the significance of ambiguous lesions of the left main coronary artery. Surgery is associated with much better outcomes than medical therapy and is considered by many to be the standard of care in patients who are surgical candidates. Recent studies comparing surgery with percutaneous coronary intervention (PCI) have defined subgroups with lesser extent of disease burden that may do just as well with PCI. Challenges remain in the management of bifurcation disease, and the interventional community anxiously awaits the results of the large-scale randomized trials comparing PCI with surgery.
Collapse
|
57
|
Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Thorac Cardiovasc Surg 2014; 149:e5-23. [PMID: 25827388 DOI: 10.1016/j.jtcvs.2014.11.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
58
|
Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. Circulation 2014; 130:1749-67. [DOI: 10.1161/cir.0000000000000095] [Citation(s) in RCA: 388] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
59
|
Abstract
Though coronary bypass graft surgery (CABG) has traditionally been the cornerstone of therapy in patients with unprotected left main coronary artery (ULMCA) disease, recent evidence supports the use of percutaneous coronary intervention in appropriate patients. Indeed in patients with ULMCA disease, drug-eluting stents (DES) have shown similar incidence of hard end points, fewer periprocedural complications and lower stroke rates compared with CABG, though at the cost of increased revascularization with time. Furthermore, the availability of newer efficacious and safer DES as well as improvements in diagnostic tools, percutaneous techniques and, importantly, a better patient selection, allowed percutaneous coronary intervention a viable alternative to CABG of left main-patients with low disease complexity; however, even in this interventional era characterized by efficacious DES, patients with ULMCA disease remain a challenging high-risk population where outcomes strongly depend on clinical characteristics, anatomical disease complexity and extension and operator's experience. This review summarizes the role of DES in ULMCA disease patients.
Collapse
Affiliation(s)
- Chiara Bernelli
- Interventional Cardiology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| |
Collapse
|
60
|
Ali L, Malik SN, Khalid AB, Sultan M, Sadiq N. Safety and technical success of percutaneous left main coronary artery stenting. Pak J Med Sci 2014; 30:735-8. [PMID: 25097507 PMCID: PMC4121688 DOI: 10.12669/pjms.304.4859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/17/2014] [Accepted: 05/12/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Critical stenosis of left main coronary artery (LMCA) has always remained a challenge for interventional cardiologists. Conventionally Coronary Artery Bypass Grafting (CABG) is done for these patients but recently Percutaneous Coronary Intervention (PCI) is also being tried more frequently, but data of PCI is scarce in this regard. Our objective was to determine the safety and technical success rate of percutaneous left main coronary artery stenting. METHODS This was 12 month follow up study conducted at Pakistan Institute of Medical Sciences (PIMS), Islamabad from 11(th) Jan 2012 to 11(th) Jan 2013. All symptomatic patients who underwent coronary angiogram at PIMS and were found to have either isolated LMCA disease or coexisting osteal Left Anterior Descending (LAD) artery disease were potentially eligible for the study. Patients who had previous surgical treatment for coronary artery disease and those with renal dysfunction requiring dialysis were excluded. Patients were counselled in detail regarding the pros and cons of PCI versus CABG.Those who opted for PCI were included in the study. All these patients were treated with percutaneous left main coronary artery stenting with or without osteal LAD stenting. RESULTS Seventy two patients had LMCA disease during angiogram. Fifteen patients opted for CABG. Four patients did not meet the inclusion criteria, whereas 53 patients were finally enrolled. Mean age of patients were 55.45±10.275 years. Twenty nine patients were with acute coronary syndrome and 22 presented with unstable angina.PCI with stenting was technically successful in all patients. One patient died three months after PCI, there was no other mortality. CONCLUSION Our study showed that Percutaneous Coronary Intervention (PCI) to LMS has good technical success rate; the safety of the procedure is also acceptable.
Collapse
Affiliation(s)
- Liaqat Ali
- Liaqat Ali, FCPS (Medicine), Department of Cardiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Shahid Nawaz Malik
- Shahid Nawaz Malik, MRCP, Interventional cardiologist, Head of Department of Cardiology, Department of Cardiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | | | - Mehboob Sultan
- Mehboob Sultan, FCPS (Pediatrics), AFIC/NIHD. Rawalpindi, Pakistan. Armed Forces Institute of Cardiology & National Institute of Heart Diseases AFIC/NIHD, Rawalpindi, Pakistan
| | - Nadeem Sadiq
- Nadeem Sadiq, FCPS (Pediatrics), Armed Forces Institute of Cardiology & National Institute of Heart Diseases AFIC/NIHD, Rawalpindi, Pakistan
| |
Collapse
|
61
|
Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2014; 64:1929-49. [PMID: 25077860 DOI: 10.1016/j.jacc.2014.07.017] [Citation(s) in RCA: 554] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
62
|
Yokota S, Ottervanger JP, Mouden M, Timmer JR, Knollema S, Jager PL. Prevalence, location, and extent of significant coronary artery disease in patients with normal myocardial perfusion imaging. J Nucl Cardiol 2014; 21:284-90. [PMID: 24469846 DOI: 10.1007/s12350-013-9837-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND False-negative myocardial perfusion imaging (MPI) can by due to left main (LM) or three-vessel disease causing "balanced ischemia". However, so far prevalence of LM or three-vessel-disease in patients with normal MPI is unclear. We assessed prevalence, location, and extent of significant coronary artery disease (CAD) in patients with normal MPI. METHODS Between 2006 and 2010, 256 patients with normal MPI who had invasive angiography because of persisting or worsening of the same initial symptoms were studied. Significant CAD was defined as stenosis > 70% or LM > 50%. RESULTS A total of 93 patients (36%) had significant CAD. Significant CAD was observed more frequently in males, higher age and those with typical angina complaints. Significant LM disease was present in 7%, three-vessel disease in 10%, two-vessel disease in 22%, and single vessel disease (not left main) in 61%. In those with single vessel disease, the location was the LAD in 40%, the RCA in 30%, and the LCX in 30%. CONCLUSIONS In selected patients with normal MPI, one-third had significant CAD. The majority of these patients had single vessel disease (not left main). LM or three vessel disease, causing "balanced ischemia", is a less common cause of false-negative MPI.
Collapse
Affiliation(s)
- Shu Yokota
- Department of Cardiology, Isala Klinieken, Dokter Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | | | | | | | | | | |
Collapse
|
63
|
Abdolrahimi S, Sanati H, Fatahian A. Evaluation of Percutaneous Coronary Intervention and stenting of Left Main Coronary Artery Stenosis in Tehran's Rajaie and Lavasani Hospitals from 2010 to 2011. Res Cardiovasc Med 2013; 2:181-4. [PMID: 25478520 PMCID: PMC4253777 DOI: 10.5812/cardiovascmed.12594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 06/01/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Data of the results from treatment of unprotected and protected LMCA diseases with PCI and stent implantations in our country were limited. Surgical therapy is considered as an standard care for patients with unprotected LMCA stenosis. This notion is based on some randomized and observational studies performed three decades ago which convincingly showed superiority of CABGs over medical therapy. Moreover, preliminary studies have shown that the use of DES for the treatment of unprotected LMCA diseases is associated with very favorable mid-term outcome, which is highly competitive with that of surgery, especially for ostial lesions. OBJECTIVES This study sought to evaluate one year safety and effectiveness of PCI and stenting in LMCA disease. PATIENTS AND METHODS We performed a one year clinical follow-up of any patients with LMCA disease "Protected and Unprotected" who underwent PCI and stenting (n = 40) with BMS (n = 17) or DES (n = 23) in Tehran's Rajaje and Lavasani hospitals from September 2010 to September 2011. The primary end points were all-cause mortality, and MACCE which consisted of the composite of death, MI, stroke, and target vessel revascularization, and the duration of hospitalization change the severity of angina pain and the function class of physical activity. RESULTS In the one year follow-up, the adjusted risk of death was 5% and the composite of death, MI, stroke and target vessel revascularization (MACCE) was 22%. In 94.7% the number of patients, the severity of angina pain were decreased, and in 92.5% of patients, the function class of physical activity has been improved. The duration of hospitalization was 4.38 ± 1.63 days which was less than that of CABGs. CONCLUSIONS For the treatment of protected and unprotected LMCA diseases, PCI with stent implantation is effective, and leads to decreasing the mortality and the death rate, MI, stroke, the severity of angina pain, and improving the function class of physical activity and tolerance.
Collapse
Affiliation(s)
- Safarali Abdolrahimi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hamidreza Sanati
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Alireza Fatahian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
64
|
Ali M, Hanley A, McAdam B, O'Hanlon R, Gumbrielle T, Sheahan R, Foley DP. Long-term clinical outcomes after unprotected left main coronary artery stenting in an all-comers patient population. Catheter Cardiovasc Interv 2013; 82:E411-8. [PMID: 23404813 DOI: 10.1002/ccd.24861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 01/18/2013] [Accepted: 01/27/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND The goal of treating patients with coronary artery disease is to improve survival and relieve symptoms. Several studies have compared the safety and efficacy of left main coronary artery (LMCA) stenting and coronary-artery bypass grafting in case control and randomized trials. OBJECTIVE In this study we present the long term outcome of stenting unprotected LMCA stenosis in day to day practice in unselected patients. METHODS One hundred and fifty eight patients were prospectively recruited with symptomatic unprotected LMCA stenosis undergoing percutaneous coronary intervention (PCI). Using the euroSCORE, each patient's surgical mortality risk was estimated. Study end-points were any major adverse cardiac event (MACE) defined as cardiac death, nonfatal myocardial infarction, or target lesion revascularization at follow-up with either CABG or repeat PCI. RESULTS The mean follow-up was 54 ± 25 months. The mean euroSCORE was 10.6 ± 13.4 (0.9-71) and the mean SYNTAX score was 39.6 ± 10.7 (10-65). The MACE rate was 11.4% at a mean follow up of 54 months. Six (3.8%) patients suffered postprocedure myocardial infarction. There were 24 (15%) deaths of which 12 were cardiac (mean euroSCORE 21.6 ± 5.5 P < 0.001). Repeat angiography was performed in 88 (55.7%) patients. Seven (4.4%) patients had in-stent restenosis; three occurred in BMS (P = 0.06). Two patients underwent revascularization with CABG and five had successful repeat PCI. CONCLUSION In this on-going registry of high risk patients with LMCA stenosis, stenting was found to be safe and clinically effective in maintaining event-free survival.
Collapse
Affiliation(s)
- Mohammed Ali
- Department of Cardiology, Beaumont Hospital, Ireland
| | | | | | | | | | | | | |
Collapse
|
65
|
Bittl JA, He Y, Jacobs AK, Yancy CW, Normand SLT. Bayesian Methods Affirm the Use of Percutaneous Coronary Intervention to Improve Survival in Patients With Unprotected Left Main Coronary Artery Disease. Circulation 2013; 127:2177-85. [DOI: 10.1161/circulationaha.112.000646] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John A. Bittl
- From the Ocala Heart Institute, Munroe Regional Medical Center, Ocala, FL (J.A.B.); Department of Health Care Policy, Harvard Medical School, Boston, MA (Y.H., S.-L.T.N.); Department of Medicine, Section of Cardiology, Boston Medical Center, Boston, MA (A.K.J.); Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.)
| | - Yulei He
- From the Ocala Heart Institute, Munroe Regional Medical Center, Ocala, FL (J.A.B.); Department of Health Care Policy, Harvard Medical School, Boston, MA (Y.H., S.-L.T.N.); Department of Medicine, Section of Cardiology, Boston Medical Center, Boston, MA (A.K.J.); Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.)
| | - Alice K. Jacobs
- From the Ocala Heart Institute, Munroe Regional Medical Center, Ocala, FL (J.A.B.); Department of Health Care Policy, Harvard Medical School, Boston, MA (Y.H., S.-L.T.N.); Department of Medicine, Section of Cardiology, Boston Medical Center, Boston, MA (A.K.J.); Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.)
| | - Clyde W. Yancy
- From the Ocala Heart Institute, Munroe Regional Medical Center, Ocala, FL (J.A.B.); Department of Health Care Policy, Harvard Medical School, Boston, MA (Y.H., S.-L.T.N.); Department of Medicine, Section of Cardiology, Boston Medical Center, Boston, MA (A.K.J.); Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.)
| | - Sharon-Lise T. Normand
- From the Ocala Heart Institute, Munroe Regional Medical Center, Ocala, FL (J.A.B.); Department of Health Care Policy, Harvard Medical School, Boston, MA (Y.H., S.-L.T.N.); Department of Medicine, Section of Cardiology, Boston Medical Center, Boston, MA (A.K.J.); Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N.)
| |
Collapse
|
66
|
Mohamad T, Panaich SS, Alani A, Badheka A, Shenoy M, Mohamad B, Kanaan E, Ali O, Elder M, Schreiber TL. Racial disparities in left main stenting: insights from a real world inner city population. J Interv Cardiol 2013; 26:43-8. [PMID: 23330830 DOI: 10.1111/j.1540-8183.2013.12012.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Left main coronary artery (LMCA) disease is associated with significant cardiovascular mortality. The data on patient characteristics' predicting outcomes after LMCA revascularization is sparse. METHODS A retrospective study of 227 patients with LMCA disease documented on coronary angiography from March 2000 to December 2008. Data included demographic variables, co-morbidities, cardiac function, and medications. Race was self-identified. The study outcome was a composite end-point including myocardial infarction (MI) and all-cause mortality. Cox proportional hazard analysis was performed to study the effect of various patient attributes including race and gender on the composite end-point. RESULTS Baseline characteristics were specifically compared between individuals who had the study outcome versus those who did not. Mean age was higher in the group with study outcomes when compared to the group without any outcomes (64.3 ± 11.8 years versus 59.2 ± 13.6 years; p = 0.013). After the final multivariate regression analysis, only African American (AA) race and age were found to be independent predictors of adverse cardiac outcome at the end of the first year (race-hazard ratio (HR) 3.82, 95% confidence interval (CI) 1.38-10.62, p = 0.010; age-HR 1.08, 95% CI 1.04-1.13, p < 0.001) and at the end of the study (race-HR 2.71, 95% CI 1.44-5.10, p = 0.002; age-HR 1.03, 95% CI 1.01-1.08, p = 0.017). CONCLUSION In our study of patients with unprotected LMCA disease, AA race, and age were significantly predictive of poor prognosis following revascularization, while gender had no predictive value in prognosticating cardiovascular mortality.
Collapse
Affiliation(s)
- Tamam Mohamad
- Department of Cardiology, Detroit Medical Center, Detroit, Michigan 48823, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
67
|
Is percutaneous coronary intervention as effective as bypass surgery in left main stem coronary artery stenosis? Herz 2013; 38:147-52. [DOI: 10.1007/s00059-012-3745-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
68
|
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012. [PMID: 23182125 DOI: 10.1016/j.jacc.2012.07.013] [Citation(s) in RCA: 1227] [Impact Index Per Article: 102.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
69
|
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126:e354-471. [PMID: 23166211 DOI: 10.1161/cir.0b013e318277d6a0] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
70
|
Jang JS, Choi KN, Jin HY, Seo JS, Yang TH, Kim DK, Kim DS, Urm SH, Chun JH, Kang SJ, Park DW, Lee SW, Kim YH, Lee CW, Park SW, Park SJ. Meta-analysis of three randomized trials and nine observational studies comparing drug-eluting stents versus coronary artery bypass grafting for unprotected left main coronary artery disease. Am J Cardiol 2012; 110:1411-8. [PMID: 22877423 DOI: 10.1016/j.amjcard.2012.06.051] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 06/25/2012] [Accepted: 06/25/2012] [Indexed: 11/26/2022]
Abstract
Clinical outcomes for unprotected left main coronary artery (ULMCA) disease between coronary artery bypass grafting (CABG) and drug-eluting stents (DESs) remain controversial. We aimed to compare the safety and efficacy of percutaneous coronary intervention (PCI) using DESs with CABG in patients with ULMCA disease. Databases were searched for clinical studies that reported outcomes after PCI with DESs and CABG for treatment of ULMCA disease. End points of this meta-analysis were mortality; composite of death, myocardial infarction (MI), or stroke; and target vessel revascularization at 1-year follow-up. Pooled effects were calculated using fixed-effects model (Mantel-Haenszel method) or random-effects models (Dersimonian-Laird method). Twelve clinical studies (3 randomized trials and 9 observational studies) with 5,079 patients were involved in this study. At 1-year follow-up, there were trends toward lower risk of death (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.45 to 1.02) and the composite end point of death, MI, or stroke (OR 0.70, 95% CI 0.49 to 1.00) in the DES group compared to the CABG group. However, target vessel revascularization was significantly higher in the DES group compared to the CABG group (OR 3.52, 95% CI 2.72 to 4.56). In conclusion, PCI with DESs is associated with favorable outcomes for mortality; composite end point of death, MI, or stroke; and a higher risk of target vessel revascularization compared to CABG in patients with ULMCA disease.
Collapse
|
71
|
Ragosta M. The Complexity Involved in Assessment of Left Main Coronary Artery Disease. JACC Cardiovasc Interv 2012; 5:1026-8. [DOI: 10.1016/j.jcin.2012.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 07/11/2012] [Accepted: 07/19/2012] [Indexed: 10/27/2022]
|
72
|
Watanabe S, Komiya T, Sakaguchi G, Shimamoto T. Unprotected left main coronary artery disease in patients with low predictive risk of mortality. Ann Thorac Surg 2012; 94:1927-33. [PMID: 22975645 DOI: 10.1016/j.athoracsur.2012.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/22/2012] [Accepted: 06/26/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND There has been an increasing use of percutaneous coronary intervention with drug-eluting stent (DES) in patients with unprotected left main coronary artery disease. We assessed whether coronary artery bypass grafting (CABG) would be superior to percutaneous coronary intervention with first-generation DES in patients with unprotected left main coronary artery disease. METHODS Between January 2003 and December 2007, a total of 295 patients with unprotected left main coronary artery disease were treated with Kurashiki Central Hospital, Okayama, Japan. Among these patients, 169 and 126 underwent CABG and percutaneous coronary intervention with DES, respectively. The average Society of Thoracic Surgeons' predictive risk of mortality score was 2.3±3.8%. We defined higher-risk and lower-risk patients as those with Society of Thoracic Surgeons' predictive risk of mortality scores higher than 2.3% (CABG, n=48; percutaneous coronary intervention, n=28) and lower than 2.3% (CABG, n=121; percutaneous coronary intervention, n=98), respectively. Survival, major adverse cardiac-related events, and target lesion revascularization were analyzed by the Kaplan-Meier method. RESULTS Between-group differences in favor of CABG were seen with respect to the rate of major adverse cardiac-related events and target lesion revascularization in both strata. In patients with lower scores according to the Society of Thoracic Surgeons' predictive risk of mortality, the cardiac death-free survival rate was significantly higher in CABG. CONCLUSIONS In this 5-year single-center experience, CABG is recommended for unprotected left main coronary artery disease, especially in patients with low scores in the Society of Thoracic Surgeons' predictive risk of mortality.
Collapse
Affiliation(s)
- Shun Watanabe
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
| | | | | | | |
Collapse
|
73
|
Gundert TJ, Marsden AL, Yang W, Marks DS, LaDisa, Jr JF. Identification of Hemodynamically Optimal Coronary Stent Designs Based on Vessel Caliber. IEEE Trans Biomed Eng 2012; 59:1992-2002. [DOI: 10.1109/tbme.2012.2196275] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
74
|
Revascularization for left main and multivessel coronary artery disease in the drug-eluting stent era: integration of recent drug-eluting stent trials. Curr Cardiol Rep 2012; 14:468-76. [PMID: 22638907 DOI: 10.1007/s11886-012-0274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
As older patients comprise a greater proportion of the population, the incidence of multivessel and left main coronary artery disease is increasing. Given the improvements in percutaneous coronary intervention, more patients are suitable for this revascularization strategy. However, the optimal revascularization strategy remains a moving target. Numerous trials, extending from the bypass surgery versus medical therapy era to the most current drug-eluting stent versus bypass surgery era, provide information to select the most appropriate revascularization strategy. The objective of this review is to summarize these data.
Collapse
|
75
|
Cao C, Manganas C, Bannon P, Vallely M, Yan TD. Drug-eluting stents versus coronary artery bypass graft surgery in left main coronary artery disease: a meta-analysis of early outcomes from randomized and nonrandomized studies. J Thorac Cardiovasc Surg 2012; 145:738-47. [PMID: 22405674 DOI: 10.1016/j.jtcvs.2012.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/15/2012] [Accepted: 02/03/2012] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The present meta-analysis aimed to compare the short-term safety and efficacy of drug-eluting stents and coronary artery bypass graft surgery for patients with left main coronary artery disease. METHODS Fourteen relevant studies were identified from 5 electronic databases. End points included mortality, stroke, myocardial infarction, repeat revascularization, and major adverse cardiac and cerebrovascular events. RESULTS Results indicate that all-cause mortality was similar between drug-eluting stents and coronary artery bypass grafting at 30 days and at follow-up beyond 1 year. Likewise, the incidence of myocardial infarction was similar between drug-eluting stents and coronary artery bypass grafting at 12 months and at follow-up beyond 1 year. However, drug-eluting stents were associated with a lower incidence of all-cause mortality at 12 months and a higher incidence of myocardial infarction at 30 days compared with coronary artery bypass grafting. Drug-eluting stents were consistently associated with a higher incidence of repeat revascularization, whereas coronary artery bypass grafting had a higher incidence of stroke. The incidence of major adverse cardiac and cerebrovascular events was similar between the 2 groups at 30 days but higher for drug-eluting stents at 12 months and beyond. CONCLUSIONS Patients treated by drug-eluting stents in randomized controlled trials and observational studies in the current literature are often a preselected subgroup with less complex lesions compared with the overall target population. Results drawn from these studies should be viewed with caution. Coronary artery bypass grafting is associated with a lower incidence of major adverse cardiac and cerebrovascular events at 1 year and beyond, and thus should be regarded as the standard of treatment. However, drug-eluting stents may have a role for selected patients with percutaneously amenable left main disease who are poor surgical candidates.
Collapse
Affiliation(s)
- Christopher Cao
- The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia
| | | | | | | | | |
Collapse
|
76
|
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1724] [Impact Index Per Article: 132.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
77
|
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 896] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
78
|
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
79
|
Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e123-210. [PMID: 22070836 DOI: 10.1016/j.jacc.2011.08.009] [Citation(s) in RCA: 576] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
80
|
Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:e652-735. [PMID: 22064599 DOI: 10.1161/cir.0b013e31823c074e] [Citation(s) in RCA: 390] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
81
|
Abstract
Coronary artery disease with left main stenosis is associated with the highest mortality of any coronary lesion. Studies in the 1970s and 1980s comparing coronary artery bypass grafting (CABG) and medical therapy showed a significant survival benefit with revascularization. In the angioplasty era, initial experience with percutaneous intervention was associated with poor clinical outcomes. As a result, percutaneous coronary intervention (PCI) was restricted to patients who were considered inoperable, or those with prior CABG with a functional graft to the left anterior descending or circumflex artery ("protected left main disease"). With the introduction of drug-eluting stents, there are new studies demonstrating comparable survival in patients who were revascularized using PCI and CABG, although percutaneous revascularization is associated with a higher rate of repeat revascularization. In the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) trial, the combined incidence of death, myocardial infarction, and stroke was similar between the CABG and PCI groups; however, the stroke rate was higher in the CABG group. The degree and extent of disease as defined by the SYNTAX scoring system has allowed for stratification of risk and improved assignment of patients with left main stenosis to either PCI or CABG.
Collapse
|
82
|
Wu X, Chen Y, Kubo T, Ge C, Ren F, Wu X, Chen W, Zhou Hong Liu Y, Lv S. Long-term (4-year) outcomes and predictors of adverse cardiac events after sirolimus-eluting stent implantation in unprotected left main coronary artery. Int Heart J 2011; 51:377-82. [PMID: 21173511 DOI: 10.1536/ihj.51.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The 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.
Collapse
Affiliation(s)
- Xiaofan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Wakayama, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
83
|
Rittger H, Rieber J, Kögler K, Sinha A, Schmidt M, Breithardt OA, Biggar P, Einsle F, Diegeler A, Brachmann J. Clinical outcome and quality of life after interventional treatment of left main disease with drug-eluting-stents in comparison to CABG in elderly and younger patients. Clin Res Cardiol 2010; 100:439-46. [DOI: 10.1007/s00392-010-0262-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 11/16/2010] [Indexed: 11/29/2022]
|
84
|
Kim U, Park JS, Seol SH, Yang TH, Kim SM, Kim DK, Kim DI, Kim DS, Lee WJ, Lee SH, Hong GR, Shin DG, Kim YJ, Shim BS, Cho YK, Kim HS, Nam CW, Hur SH, Kim KB, Kim YN. Two-year outcomes of the sirolimus-eluting stent according to unprotected left main lesion. Clin Cardiol 2010; 32:332-6. [PMID: 19569064 DOI: 10.1002/clc.20563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The data of long-term outcomes of sirolimus-eluting stent (SES) according to lesion location of unprotected left main coronary artery (LMCA) is scarce. HYPOTHESIS The purpose of this study was to evaluate the long-term outcomes after implantation of the SES in LMCA. METHODS A total of 84 patients (51 males) who had undergone SES implantation for the treatment of native LMCA stenosis were enrolled. The patients were divided into 2 groups based on angiographic lesion location: those with significant stenosis in the ostium and/or body (group 1; n = 39) and those involving bifurcation (group 2; n = 45). RESULTS All of the group 1 patients were treated with simple lesion coverage while different stenting techniques were used in group 2 (cross-over: 44.8%, T: 6.7%, kissing: 37.8%, and crush techniques: 11.1%). The 8-month quantitative angiographic findings and in-hospital and 2 year rates of major adverse cardiac events (MACE) were compared between the 2 groups. Although angiographic success and in-hospital MACE rates were similar in both groups with 1 cardiac death due to acute stent thrombosis in group 2, at 2-year follow-up, the MACE rate was significantly higher in group 2 than in group 1 at 2 years (22.2% vs 2.6%, respectively, P = 0.008). Coronary angiography revealed a significantly higher binary restenosis rate in group 2 compared with group 1 (20% vs 0%, respectively, P = 0.003). CONCLUSIONS Interventional treatment using SES in left main lesions showed favorable short-term and long-term outcomes in selected patients with lesion location being an important determinant of clinical and angiographic outcomes.
Collapse
Affiliation(s)
- Ung Kim
- Cardiology Division, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
85
|
THOMPSON CRAIGA, SIDHU MANDEEPS, BROWN JEREMIAHR, SABIR SAJJADA, FLOYD KEVINC, DE VRIES JAMEST, JAYNE JOHNE, FRIEDMAN BRUCEJ, HETTLEMAN BRUCED, NILES NATHANIELW, ROBB JOHNF, MALENKA DAVIDJ, KAPLAN AARONV. Classification and Atherosclerosis Distribution in Patients with Left Main Coronary Disease. J Interv Cardiol 2009; 22:431-6. [DOI: 10.1111/j.1540-8183.2009.00490.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
86
|
|
87
|
Anselmino M, Biondi-Zoccai G, Moretti C, Sheiban I. Percutaneous coronary intervention on left main coronary artery trifurcation. Heart Vessels 2008; 23:279-81. [PMID: 18649059 DOI: 10.1007/s00380-008-1049-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 02/14/2008] [Indexed: 02/08/2023]
|
88
|
Taggart DP, Kaul S, Boden WE, Ferguson TB, Guyton RA, Mack MJ, Sergeant PT, Shemin RJ, Smith PK, Yusuf S. Revascularization for Unprotected Left Main Stem Coronary Artery Stenosis. J Am Coll Cardiol 2008; 51:885-92. [PMID: 18308155 DOI: 10.1016/j.jacc.2007.09.067] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 08/09/2007] [Accepted: 09/07/2007] [Indexed: 10/22/2022]
|
89
|
|
90
|
Abstract
Patients with stenosis of the left main coronary artery present difficult challenges. The risks associated with this lesion have been known since the early days of angiography when patients were found to have increased mortality during follow-up. This information led to the general guidelines that surgical revascularization should be considered the treatment of choice in patients with significant left main coronary artery stenosis. Current advances in invasive cardiology have brought important information to the field. Intravascular ultrasound is now used routinely to evaluate angiographically indeterminate lesions with criteria now set forward as to what constitutes an indication for revascularization. Stents have even further dramatically changed the landscape. There are substantial issues, however, that need to addressed. These include the following: (1) the effect of specific lesion location on outcome - it is known that patients with distal bifurcation left main disease have worse outcome; (2) the potential for subacute thrombosis of the left main coronary artery; (3) the impact of left ventricular function and patient comorbidities irrespective of the degree and location of left main coronary artery stenosis; and (4) the risk-benefit ratio of stenting versus coronary artery bypass graft surgery. These issues are currently being addressed in two seminally important trials including the SYNTAX trial, which randomizes patients with left main and/or three-vessel disease to either coronary artery bypass graft surgery or a TAXUS drug-eluting stent. This trial is in the final stages of patient recruitment and will have important implications for the field. The other trial is the COMBAT trial, which is focused exclusively on left main coronary artery stenosis and randomizes patients with left main coronary artery disease either to a Sirolimus-eluting stent (Cypher, Johnson and Johnson Cordis, USA) or to coronary artery bypass graft surgery. The field of left main coronary artery disease continues to expand in terms of the evidence available for optimal patient evaluation and selection of treatment modalities.
Collapse
|
91
|
Hernández Antolín RA, Fernández-Vázquez F, Moreu Burgo J, López Palop R. [Interventional cardiology 2006]. Rev Esp Cardiol 2007; 60 Suppl 1:19-32. [PMID: 17352853 DOI: 10.1157/13099710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The range of applications of percutaneous coronary intervention (PCI) continues to expand and a growing number of patients are being treated, including those with extensive cardiovascular disease, more serious comorbid conditions, and more complex lesions. Even so, the success rate is high, serious complications are rare in stable patients, and the restenosis rate has been dramatically reduced by drug-eluting stents. Nevertheless, percutaneous techniques still have major limitations restricting their use in some type of lesions, such as bifurcations and total occlusions, and their role in relation to surgical revascularization has not yet been well defined in the treatment of the left main coronary artery or multivessel disease. The development of novel types of coated stent with better mechanical characteristics and a lower risk of occlusion will further expand the ambit of PCI. The role of PCI in the management of acute coronary syndromes is already well defined, and has increased the preference for an invasive rather than a conservative approach in high-risk patients without ST elevation and the preference for primary angioplasty rather than thrombolysis in those with ST elevation. The development and implementation of integrated coronary syndrome treatment networks will enable human and material resources to be used efficiently, and will guarantee rapid access to high-quality PCI for those who need it. The potential usefulness of combining cellular therapy with interventional procedures in the treatment of acute myocardial infarction has still to be determined. At present, there is extensive research into noncoronary interventions, which, in the not too distant future, could provide percutaneous treatment for the many elderly patients with severe aortic stenosis who are not currently eligible for surgery.
Collapse
|
92
|
Kim W, Kim YJ, Lee WJ, Lee SH, Hong GR, Park JS, Shin DG, Shim BS, Cho YK, Kim HS, Nam CW, Hur SH, Kim YN, Kim KB, Yang TH, Kim DK, Kim SM, Kim DI, Kim DS. Lesion Location: Its Impacts on the Procedural and Postprocedural Outcomes of Unprotected Left Main Coronary Stenting. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.9.419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Woong Kim
- Cardiology Division, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Young-Jo Kim
- Cardiology Division, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Won-Jae Lee
- Cardiology Division, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Sang-Hee Lee
- Cardiology Division, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Geu-Ru Hong
- Cardiology Division, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jong-Seon Park
- Cardiology Division, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Dong-Gu Shin
- Cardiology Division, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Bong-Sup Shim
- Cardiology Division, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Yoon-Kyung Cho
- Department of Internal Medicine, College of Medicine, Keimyung University, Dongsan Hospital, Daegu, Korea
| | - Hyung-Seop Kim
- Department of Internal Medicine, College of Medicine, Keimyung University, Dongsan Hospital, Daegu, Korea
| | - Chang-Wook Nam
- Department of Internal Medicine, College of Medicine, Keimyung University, Dongsan Hospital, Daegu, Korea
| | - Seung-Ho Hur
- Department of Internal Medicine, College of Medicine, Keimyung University, Dongsan Hospital, Daegu, Korea
| | - Yoon-Nyun Kim
- Department of Internal Medicine, College of Medicine, Keimyung University, Dongsan Hospital, Daegu, Korea
| | - Kwon-Bae Kim
- Department of Internal Medicine, College of Medicine, Keimyung University, Dongsan Hospital, Daegu, Korea
| | - Tae-Hyun Yang
- Department of Internal Medicine, College of Medicne, Inje University, Busan Baik Hospital, Busan, Korea
| | - Dae-Kyung Kim
- Department of Internal Medicine, College of Medicne, Inje University, Busan Baik Hospital, Busan, Korea
| | - Sung-Man Kim
- Department of Internal Medicine, College of Medicne, Inje University, Busan Baik Hospital, Busan, Korea
| | - Doo-Il Kim
- Department of Internal Medicine, College of Medicne, Inje University, Busan Baik Hospital, Busan, Korea
| | - Dong-Soo Kim
- Department of Internal Medicine, College of Medicne, Inje University, Busan Baik Hospital, Busan, Korea
| |
Collapse
|