Unprotected left main coronary artery stenting

Are we there yet?

A. J. Mani, M. Karatepe, N. L. Coplan, Issam Moussa

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Left main coronary artery (LMCA) disease is found in 3%-5% of patients who undergo cardiac catheterization for chest pain syndrome, congestive heart failure, or cardiogenic shock. Coronary artery bypass grafting has been the standard of care in the management of LMCA disease, with a demonstrated survival rate superior to that achieved with medical therapy. Recent retrospective data suggest an acceptable surgical risk for coronary artery bypass grafting (without concomitant valve surgery) in patients with significant LMCA disease. These data show an in-hospital mortality of 2.3% and an overall 3-year mortality of 15.6%±2.2%. Initial experience with percutaneous coronary intervention (PCI) for LMCA disease, primarily with balloon angioplasty, was disappointing and fraught with a prohibitive procedural and 1-year mortality. The advent of stent use in PCI has introduced another option for these patients. Three recent trials of elective stenting in unprotected LMCA disease in a combined total of 243 patients at low surgical risk and with a normal left ventricular ejection fraction yielded a procedural success rate of 100%, an acute procedural mortality of 0%, a 1-year mortality of 2.0%-2.5%, and a need for subsequent revascularization of 18%-22%. The combined restenosis rate was 20%-23%. In terms of location, the restenosis rate with balloon/stent injury was higher in the distal LMCA and at the bifurcation. In the-low risk elective patient with a normal LMCA and absence of right coronary artery occlusion, it appears that PCI is an acceptable treatment approach. Critical to its success are antiplatelet pre-treatment, optimal technique, and follow-up with repeat angiography. Large, randomized clinical trials are needed to compare PCI with bypass surgery and will provide data for evidence-based management of patients with LMCA disease.

Original languageEnglish (US)
Pages (from-to)585-592
Number of pages8
JournalCardiovascular Reviews and Reports
Volume22
Issue number10
StatePublished - Jan 1 2001

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Coronary Artery Disease
Coronary Vessels
Percutaneous Coronary Intervention
Mortality
Coronary Artery Bypass
Stents
Balloon Angioplasty
Cardiogenic Shock
Coronary Occlusion
Standard of Care
Cardiac Catheterization
Hospital Mortality
Chest Pain
Stroke Volume
Angiography
Therapeutics
Survival Rate
Randomized Controlled Trials
Heart Failure
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Mani, A. J. ; Karatepe, M. ; Coplan, N. L. ; Moussa, Issam. / Unprotected left main coronary artery stenting : Are we there yet?. In: Cardiovascular Reviews and Reports. 2001 ; Vol. 22, No. 10. pp. 585-592.
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abstract = "Left main coronary artery (LMCA) disease is found in 3{\%}-5{\%} of patients who undergo cardiac catheterization for chest pain syndrome, congestive heart failure, or cardiogenic shock. Coronary artery bypass grafting has been the standard of care in the management of LMCA disease, with a demonstrated survival rate superior to that achieved with medical therapy. Recent retrospective data suggest an acceptable surgical risk for coronary artery bypass grafting (without concomitant valve surgery) in patients with significant LMCA disease. These data show an in-hospital mortality of 2.3{\%} and an overall 3-year mortality of 15.6{\%}±2.2{\%}. Initial experience with percutaneous coronary intervention (PCI) for LMCA disease, primarily with balloon angioplasty, was disappointing and fraught with a prohibitive procedural and 1-year mortality. The advent of stent use in PCI has introduced another option for these patients. Three recent trials of elective stenting in unprotected LMCA disease in a combined total of 243 patients at low surgical risk and with a normal left ventricular ejection fraction yielded a procedural success rate of 100{\%}, an acute procedural mortality of 0{\%}, a 1-year mortality of 2.0{\%}-2.5{\%}, and a need for subsequent revascularization of 18{\%}-22{\%}. The combined restenosis rate was 20{\%}-23{\%}. In terms of location, the restenosis rate with balloon/stent injury was higher in the distal LMCA and at the bifurcation. In the-low risk elective patient with a normal LMCA and absence of right coronary artery occlusion, it appears that PCI is an acceptable treatment approach. Critical to its success are antiplatelet pre-treatment, optimal technique, and follow-up with repeat angiography. Large, randomized clinical trials are needed to compare PCI with bypass surgery and will provide data for evidence-based management of patients with LMCA disease.",
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Mani, AJ, Karatepe, M, Coplan, NL & Moussa, I 2001, 'Unprotected left main coronary artery stenting: Are we there yet?', Cardiovascular Reviews and Reports, vol. 22, no. 10, pp. 585-592.

Unprotected left main coronary artery stenting : Are we there yet? / Mani, A. J.; Karatepe, M.; Coplan, N. L.; Moussa, Issam.

In: Cardiovascular Reviews and Reports, Vol. 22, No. 10, 01.01.2001, p. 585-592.

Research output: Contribution to journalArticle

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T1 - Unprotected left main coronary artery stenting

T2 - Are we there yet?

AU - Mani, A. J.

AU - Karatepe, M.

AU - Coplan, N. L.

AU - Moussa, Issam

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N2 - Left main coronary artery (LMCA) disease is found in 3%-5% of patients who undergo cardiac catheterization for chest pain syndrome, congestive heart failure, or cardiogenic shock. Coronary artery bypass grafting has been the standard of care in the management of LMCA disease, with a demonstrated survival rate superior to that achieved with medical therapy. Recent retrospective data suggest an acceptable surgical risk for coronary artery bypass grafting (without concomitant valve surgery) in patients with significant LMCA disease. These data show an in-hospital mortality of 2.3% and an overall 3-year mortality of 15.6%±2.2%. Initial experience with percutaneous coronary intervention (PCI) for LMCA disease, primarily with balloon angioplasty, was disappointing and fraught with a prohibitive procedural and 1-year mortality. The advent of stent use in PCI has introduced another option for these patients. Three recent trials of elective stenting in unprotected LMCA disease in a combined total of 243 patients at low surgical risk and with a normal left ventricular ejection fraction yielded a procedural success rate of 100%, an acute procedural mortality of 0%, a 1-year mortality of 2.0%-2.5%, and a need for subsequent revascularization of 18%-22%. The combined restenosis rate was 20%-23%. In terms of location, the restenosis rate with balloon/stent injury was higher in the distal LMCA and at the bifurcation. In the-low risk elective patient with a normal LMCA and absence of right coronary artery occlusion, it appears that PCI is an acceptable treatment approach. Critical to its success are antiplatelet pre-treatment, optimal technique, and follow-up with repeat angiography. Large, randomized clinical trials are needed to compare PCI with bypass surgery and will provide data for evidence-based management of patients with LMCA disease.

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