Coronary Interventions on Left Main Coronary Artery: Short-Term Outcomes of Routine Clinical Practice
Background. Left main coronary artery (LM) lesions observed in 4.8–9 % of patients on coronary angiography represent a serious clinical problem with a quite aggressive revascularization strategy. Despite the growing evidence for the efficacy and safety of LM percutaneous coronary interventions (PCI), coronary bypass surgery remains the preferred method of revascularization in many hospitals.
Materials and methods. The authors presented short-term results of LM PCI in 66 consecutive patients in one center.
Results. LM PCI accounted for 4.9 % of the total number of percutaneous coronary interventions. 67.2 % of PCI were performed through radial access, two-stent strategies were used in 10.8%, mechanical circulatory support in 7.5%, and intracoronary imaging in 1.5 % of cases. Hospital mortality rate was 4.5%, the complications rate was 13.6 %. There were no significant differences in terms of access, technical aspects of the procedure, the number of complications and mortality rate between elective patients and patients with acute coronary syndrome.
Conclusion. LM PCI may be performed routinely in the hospitals with wide experience in coronary interventions with acceptable short-term outcomes. Additional efforts are needed from the hospital administrations and professional societies to increase the use of coronary imaging in order to improve the long-term outcomes of LM PCI.
- Giannoglou GD, Antoniadis AP, Chatzizisis YS, Damvopoulou E, Parcharidis GE, Louridas GE. Prevalence of narrowing >or=50% of the left main coronary artery among 17,300 patients having coronary angiography. Am J Cardiol. 2007 Oct 1;100(7):1186. https://doi.org/10.1016/j.amjcard.2006.05.052
- Stone GW, Moses JW, Leon MB. Left main drug-eluting stents: natural progression or a bridge too far. J Am Coll Cardiol. 2007;50:498–500. https://doi.org/10.1016/j.jacc.2007.04.055
- Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Jan 7;40(2):87–165. https://doi.org/10.1093/eurheartj/ehy394
- SWEDEHEART [Internet]. SWEDEHEART; c2019 [cited 2019 Mar 1]. SWEDEHEART Annual Report 2017; [about 1 screen]. Available from: https://www.ucr.uu.se/swedeheart/arsrapport-2017/swedeheart-annual-report-2017
- Epstein AJ, Polsky D, Yang F, Yang L, Groeneveld PW. Coronary revascularization trends in the United States, 2001-2008. JAMA. 2011;305(17):1769–76.
- Mohr FW, Morice MC, Kappetein AP, Feldman TE, Stеhle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013 Feb 23;381(9867):629–38. https://doi.org/10.1016/S0140-6736(13)60141-5
- Morice MC, Serruys PW, Kappetein AP, Feldman TE, Stеhle E, Colombo A, et al. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. Circulation. 2014 Jun;129(23):2388–94. https://doi.org/10.1161/CIRCULATIONAHA.113.006689
- Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: A pooled analysis of individual patient data. Lancet. 2018 Mar;391(10124):939– 948. https://doi.org/10.1016S0140-6736(18)30423-9
- Capodanno D, Stone GW, Morice MC, Bass TA, Tamburino C. Percutaneous coronary intervention versus coronary artery bypass graft surgery in left main coronary artery disease: A meta-analysis of randomized clinical data. J Am Coll Cardiol. 2011 Sep;58(14):1426–32. https://doi.org/10.1016/j.jacc.2011.07.005
- Ahn JM, Roh JH, Kim YH, Park DW, Yun SC, Lee PH, et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease: 5-Year outcomes of the PRECOMBAT study. J Am Coll Cardiol. 2015 May;65(20):2198–206. https://doi.org/10.1016/j.jacc.2015.03.033
- Cavalcante R, Sotomi Y, Lee CW, Ahn JM, Farooq V, Tateishi H, et al. Outcomes after percutaneous coronary intervention or bypass surgery in patients with unprotected left main disease. J Am Coll Cardiol. 2016 Sep;68(10):999– 1009. https://doi.org/10.1016/j.jacc.2016.06.024
- Giacoppo D, Colleran R, Cassese S, Frangieh AH, Wiebe J, Joner M, et al. Percutaneous coronary intervention vs coronary artery bypass grafting in patients with left main coronary artery stenosis: A systematic review and meta-analysis. JAMA Cardiol. 2017 Oct;2(10):1079–1088. https://doi.org/10.1001/jamacardio.2017.2895
- De Maria GL, Burzotta F, Trani C, Kassimis G, Pirozzolo G, Patel N, et al. Trends and outcomes of radial approach in left-main bifurcation percutaneous coronary intervention in the drug-eluting stent era: a two-center registry. J Invasive Cardiol. 2015;27:E125–136.
- Lassen JF, Holm NR, Banning A, Burzotta F, Lefиvre T, Chieffo A, et al. Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. EuroIntervention. 2016 May;12(1):38–46. https://doi.org/10.4244/EIJV12I1A7
- Sawaya FJ, Lefиvre T, Chevalier B, Garot P, Hovasse T, Morice MC, et al. Contemporary Approach to Coronary Bifurcation Lesion Treatment. JACC Cardiovasc Interv. 2016 Sep;9(18):1861–78. https://doi.org/10.1016/j.jcin.2016.06.056
- Katritsis DG, Siontis GC, Ioannidis JP. Double versus single stenting for coronary bifurcation lesions: a meta-analysis. Circ Cardiovasc Interv. 2009;2:409–15.
- Hildick-Smith D, Behan MW, Lassen JF, Chieffo A, Lefиvre T, Stankovic G, et al. The EBC TWO Study (European Bifurcation Coronary TWO): A Randomized Comparison of Provisional T-Stenting Versus a Systematic 2 Stent Culotte Strategy in Large Caliber True Bifurcations. Circ Cardiovasc Interv. 2016 Sep;9(9). pii: e003643. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003643
- Chieffo A, Hildick-Smith D. The European Bifurcation Club Left Main Study (EBC MAIN): rationale and design of an international, multicentre, randomised comparison of two stent strategies for the treatment of left main coronary bifurcation disease. EuroIntervention 2016 May 17;12(1):47–52. https://doi.org/10.4244/EIJV12I1A8
- Rahman S, Leesar T, Cilingiroglu M, Effat M, Arif I, Helmy T, Leesar MA. Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions: a serial volumetric intravascular ultrasound study. JACC Cardiovasc Interv. 2013 Sep;6(9):923–31.
- Sgueglia GA, Chevalier B. Kissing balloon inflation in percutaneous coronary interventions. J Am Coll Cardiol Intv. 2012;5:803–11.
- Murasato Y, Finet G, Foin N. Final kissing balloon inflation: the whole story. EuroIntervention. 2015;11 Suppl V:V81–5. https://doi.org/10.4244/EIJV11SVA18
- Niemela # M, Kervinen K, Erglis A, Holm NR, Maeng M, Christiansen EH, et al. Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic-Baltic Bifurcation Study III. Circulation. 2011 Jan;123(1):79–86. https://doi.org/10.1161/CIRCULATIONAHA.110.966879
- Song YB, Park TK, Hahn JY, Yang JH, Choi JH, Choi SH, et al. Optimal strategy for provisional side branch intervention in coronary bifurcation lesions: 3-year outcomes of the SMART-STRATEGY Randomized Trial. JACC Cardiovasc Interv. 2016 Mar;9(6):517–26. https://doi.org/10.1016/j.jcin.2015.11.037
- Park SJ, Kim YH, Park DW, Lee SW, Kim WJ, Suh J, et al. Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interv. 2009 Jun;2(3):167–77. https://doi.org/10.1161/CIRCINTERVENTIONS.108.799494
- Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): Final 12 month results of a randomised, open-label trial. Lancet. 2013 Nov;382(9905):1638–45. https://doi.org/10.1016/S0140-6736(13)61783-3