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Long Term Outcome of Unprotected Left Main Stem Percutaneous Coronary Intervention, a Single Centre Experience

ORIGINAL RESEARCH, November 2014, VOL III ISSUE I, ISSN 2042-4884
10.5083/ejcm.20424884.127 , Cite or Link Using DOI
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Egred M, Ang DSC, Edwards R, Das R, Bagnall AJ, Purcell IF, Zaman AG, Ahmed JM

ABSTRACT

Percutaneous coronary intervention (PCI) is increasingly used for unprotected left main coronary artery disease (UPLMS) revascularization. Data regarding long-term mortality in this subset of patients remain sparse. We aim to present our outcome data on all comers who had UPLMS PCI.

Methods: Retrospective dataset analysis of prospectively collected data evaluating all UPLMS PCI performed in a large tertiary cardiac centre, between September 2003 and December 2012.Long-term mortality data were available over a median duration of 21 months (IQR 10 months to 43 months).

Results: In total there were 483 procedures performed. The cohort consisted of 58% with non ST elevation myocardial infarction (NSTEMI), 17% with STEMI and 25% with stable angina (SA). The overall in-hospital and long-term mortality were 7% and 22% respectively. The in-hospital mortality was 23%, 6%, and 1.6% in STEMI, NSTEMI, and SA respectively. Long-term mortality was 31% in STEMI patients, 26% in NSTEMI and 10% in SA. The use of drug eluting stents (DES) [adjusted RR 0.40 (95% CI, 0.23-0.69)] and Intravascular ultrasound (IVUS) [adjusted RR 0.17 (95% CI 0.04-0.72)] were independently associated with improved long-term survival.

Conclusion: UPLMS PCI is associated with favourable long-term survival. The use of DES and IVUS guided PCI appear to be associated with improved long-term outcome and should be considered in the routine management of this cohort of patients.