open access

Vol 64, No 1 (2006)
Other
Published online: 2006-01-23
Submitted: 2012-12-28
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ORIGINAL ARTICLE
Stent implantation for the unprotected left main coronary artery. The long-term outcome of 62 patients

Ewa Peszek-Przybyła, Paweł Buszman, Bożena Białkowska, Aleksander Żurakowski, Iwona Banasiewicz-Szkróbka, Marcin Dębiński, Michał Tendera
Kardiol Pol 2006;64(1):1-6.

open access

Vol 64, No 1 (2006)
Other
Published online: 2006-01-23
Submitted: 2012-12-28

Abstract

Introduction: Stent implantation for the unprotected left main coronary artery (ULMCA) is regarded as controversial and coronary heart disease with LMCA stenosis still remains a basic indication for bypass surgery. Although there is no doubt that the risk of stent implantation for LMCA lesions is low, there are still limited data on long-term outcomes. There have been no reports so far answering the question whether ULMCA stenting ensures adequate coronary blood flow in the vessel. Aim: Assessment of the effect of LMCA flow restoration with stenting on the coronary flow reserve assessed by an exercise test, as well as on left ventricular function and angina in patients followed for 12 months after the procedure. Methods: The study population included 62 patients (17 women and 45 men) aged 61.4±11.1 (35-84 years) who underwent coronary angioplasty with elective ULMCA stenting. In all patients, serial echocardiography (before and 1, 3, 6, and 12 months after the procedure) and the exercise test according to the Bruce protocol (1, 3, 6, 12 months after the procedure) were carried out. Routine coronary angiography was performed 3 to 6 months after the procedure. Fifty-nine patients (95.2%) survived a 12-month period. In 24 (38.7%) patients major adverse cardiac events (MACE) occurred. In-stent restenosis was observed in 13 patients; in 11 of them repeated PCI was performed and 2 of them underwent CABG. One patient after repeated PCI required CABG. Results: Severity of angina, evaluated according to the CCS scale, decreased significantly in the 12-month follow-up period as compared with the preprocedural period (p <0.00001). The mean baseline left ventricular ejection fraction was 51.6±12.5%. It increased to 53.8±12.8% (p <0.02) at 6 months and remained at this level at 12 months. The mean exercise test time was 7.0±3.4 minutes in the first month after ULMCA stenting, and in the sixth and the twelfth month of follow-up it increased to 7.6±3.4 minutes (p <0.002) and 7.8±3.2 minutes (p <0.05), respectively. The metabolic equivalent task (MET) value did not change significantly during the observation period. Conclusions: Restoration of the physiological blood flow in the unprotected left main coronary artery with stent implantation is associated with a significant reduction of angina, significant improvement of the left ventricular systolic function and preservation of exercise capacity in long-term follow-up.

Abstract

Introduction: Stent implantation for the unprotected left main coronary artery (ULMCA) is regarded as controversial and coronary heart disease with LMCA stenosis still remains a basic indication for bypass surgery. Although there is no doubt that the risk of stent implantation for LMCA lesions is low, there are still limited data on long-term outcomes. There have been no reports so far answering the question whether ULMCA stenting ensures adequate coronary blood flow in the vessel. Aim: Assessment of the effect of LMCA flow restoration with stenting on the coronary flow reserve assessed by an exercise test, as well as on left ventricular function and angina in patients followed for 12 months after the procedure. Methods: The study population included 62 patients (17 women and 45 men) aged 61.4±11.1 (35-84 years) who underwent coronary angioplasty with elective ULMCA stenting. In all patients, serial echocardiography (before and 1, 3, 6, and 12 months after the procedure) and the exercise test according to the Bruce protocol (1, 3, 6, 12 months after the procedure) were carried out. Routine coronary angiography was performed 3 to 6 months after the procedure. Fifty-nine patients (95.2%) survived a 12-month period. In 24 (38.7%) patients major adverse cardiac events (MACE) occurred. In-stent restenosis was observed in 13 patients; in 11 of them repeated PCI was performed and 2 of them underwent CABG. One patient after repeated PCI required CABG. Results: Severity of angina, evaluated according to the CCS scale, decreased significantly in the 12-month follow-up period as compared with the preprocedural period (p <0.00001). The mean baseline left ventricular ejection fraction was 51.6±12.5%. It increased to 53.8±12.8% (p <0.02) at 6 months and remained at this level at 12 months. The mean exercise test time was 7.0±3.4 minutes in the first month after ULMCA stenting, and in the sixth and the twelfth month of follow-up it increased to 7.6±3.4 minutes (p <0.002) and 7.8±3.2 minutes (p <0.05), respectively. The metabolic equivalent task (MET) value did not change significantly during the observation period. Conclusions: Restoration of the physiological blood flow in the unprotected left main coronary artery with stent implantation is associated with a significant reduction of angina, significant improvement of the left ventricular systolic function and preservation of exercise capacity in long-term follow-up.
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Keywords

left main coronary artery stenting; ejection fraction

About this article
Title

ORIGINAL ARTICLE
Stent implantation for the unprotected left main coronary artery. The long-term outcome of 62 patients

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 64, No 1 (2006)

Pages

1-6

Published online

2006-01-23

Bibliographic record

Kardiol Pol 2006;64(1):1-6.

Keywords

left main coronary artery stenting
ejection fraction

Authors

Ewa Peszek-Przybyła
Paweł Buszman
Bożena Białkowska
Aleksander Żurakowski
Iwona Banasiewicz-Szkróbka
Marcin Dębiński
Michał Tendera

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