Circulation. 2001;104:1609-1614
doi: 10.1161/hc3901.096669
doi: 10.1161/hc3901.096669
(Circulation. 2001;104:1609.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Long-Term Clinical Outcomes After Unprotected Left Main Trunk Percutaneous Revascularization in 279 Patients
Pittsburgh Vascular Institute, UPMC Shadyside, Pittsburgh, Pa (W.A.T.); Shiga Medical Center, Moriyama City, Japan (H.T.); Asan Medical Center, Seoul, Korea (S.-J.P.); St Antonius Ziekenhuis, Nieuwegein, Netherlands (T.P.); Kokura Memorial Hospital, Kitakyushu, Japan (M.N.); National Toyohashi Higashi Hospital, Toyohashi, Japan (T.S.); Centro Cuore Columbus, Milano, Italy (A.C.); Hospital Universitario San Carlos, Madrid, Spain (C.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Beth Israel Deaconess Hospital, Boston, Mass (D.J.C.); and the Section of Interventional Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio (P.L.W., S.G.E.).
Correspondence to Stephen G. Ellis, MD, Director, Cardiac Catheterization Laboratories, F-25, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail elliss{at}ccf.org
Background— Percutaneous coronary revascularization (PCI) has been increasingly applied to unprotected left main trunk (LMT) lesions, with varied long-term success. This study attempts to define the predictors of outcome in this population.
Methods and Results— Two hundred seventy-nine consecutive patients who had LMT PCI at 1 of 25 sites between 1993 and 1998 were studied. Forty-six percent of these patients were deemed inoperable or at high surgical risk. Thirty-eight patients (13.7%) died in hospital, and the rest were followed up for a mean of 19 months. The 1-year incidence was 24.2% for all-cause mortality, 20.2% for cardiac mortality, 9.8% for myocardial infarction, and 9.4% for CABG. Independent correlates of all-cause mortality were left ventricular ejection fraction 
30%, mitral regurgitation grade 3 or 4, presentation with myocardial infarction and shock, creatinine 
2.0 mg/dL, and severe lesion calcification. For the 32% of patients <65 years old with left ventricular ejection fraction >30% and without shock, the prevalence of these adverse risk factors was low. No periprocedural deaths were observed in this low-risk subset, and the 1-year mortality was only 3.4%.
Conclusions— Patients undergoing unprotected LMT PCI have frequent serious comorbidities and consequently have high event rates. PCI may be an alternative to CABG for a select proportion of elective patients and may also be appropriate for highly symptomatic inoperable patients. Meticulous follow-up of hospital survivors is required because of the rather high mortality during the first few months after treatment.
Key Words: angioplasty • coronary disease • revascularization • stents
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