This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Google Scholar Articles by Rademacher, W. Articles by Figulla, H. R. PubMed PubMed Citation Articles by Rademacher, W. Articles by Figulla, H. R.

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