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Acute and long-term outcome of unprotected left main coronary angioplasty compared to the anticipated surgical risk

^a Department of Cardiology, University Hospital of Jena, Erlanger Allee 101, 07747 Jena, Germany
^b Department of Cardiology, Hospital Munich-Neuperlach, Germany

*Corresponding author. Tel.: +49 3641 9324101; fax: +49 3641 9324102.

E-mail address: Wilma.Rademacher{at}med.uni-jena.de (W. Rademacher).

Objectives: Percutaneous coronary intervention of unprotected left main (ULM) stenosis is increasing despite surgical revascularisation being the recommended treatment by the current guidelines. We compared the 30-day and 9-month mortality after ULM stenting with the predicted surgical outcome as determined by the EuroSCORE. Methods and results: We included 81 consecutive patients who underwent ULM stenting. The patient cohort was divided into a normal risk group (EuroSCORE 5, predicted 30-day mortality <3%), and a high-risk group (EuroSCORE >5, predicted 30-day mortality 11%). Follow-up examinations were scheduled for one and nine months after the initial PCI. The average EuroSCOREs in the normal- and high-risk group were 3.0 (29 patients, 36%) and 10.0 (52 patients, 64%), respectively. Mortality rates at 30 days were 3% in the normal-risk group and 8% in the high-risk group. Subacute stent thrombosis occurred in 3.4% (three patients) undergoing elective PCI. Major adverse cardiac events during the nine months follow-up were registered in 24% of patients in the normal-risk group, and in 27% of the patients in the high-risk group. Conclusion: Short-term outcome of ULM stenting in our high-risk patients is comparable to surgical outcome predicted by the EuroSCORE. Long-term outcome was less favourable due to a high mortality rate. ULM stenting in patients with low surgical risk could be associated with higher mortality rates compared to CABG because of the unpredictable risk of a fatal stent thrombosis.

Key Words: Left main coronary artery; Coronary artery bypass grafting; Angioplasty; Mortality; Risk stratification

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