Patients with normal left ventricular function who undergo elective unprotected left main coronary artery percutaneous coronary intervention (PCI) with drug-eluting stents had favourable outcomes according to new research. Results of the multicentre, retrospective study are reported in the June 2011 issue of Catheterization and Cardiovascular Interventions, a journal published by Wiley-Blackwell on behalf of The Society for Cardiovascular Angiography and Interventions (SCAI).
For patients with unprotected left main coronary artery disease, coronary artery bypass grafting (CABG) is the standard of care based on medical evidence that shows a survival advantage with this intervention. Current guidelines for PCI state that unprotected left main coronary artery stenting may be an option for patients who are at high risk for adverse surgical outcomes, but have a low risk for procedural complications. In patients with severe aortic calcification, cerebrovascular disease, or limited life expectancy angioplasty may be elected over heart bypass surgery.
The present study, led by Michael Lee, University of California, Los Angeles Medical Center evaluated the safety and efficacy of unprotected left main coronary artery PCI with drug-eluting stents in patients with normal left ventricular function. Researchers used data from a multicentre international registry, identifying 221 patients who underwent elective PCI for unprotected left main coronary artery disease between 2002 and 2009. Patients in the study had a mean age of 68 years and 75% were male; 25% had diabetes, 39% had a history of heart attack, and 40% had a prior PCI.
“Our analysis confirms that elective PCI with drug-eluting stents in patients with normal left ventricular function is a safe and effective treatment for unprotected left main coronary artery disease,” said Lee.
In the first 30 days following angioplasty no cardiac death, target lesion revascularisation, stent thrombosis, or stroke were reported. While no cases of Q wave myocardial infarction occurred, seven patients had periprocedural myocardial infarction.
The authors found that event-free survival estimates for cardiac death and target lesion revascularisation at five years was 96% and 89%, respectively. Further analysis established that patient age of 75 years or older and a history of myocardial infarction were independent predictors of cardiac death.
“Research comparing the safety and efficacy of unprotected left main coronary artery PCI with drug-eluting stents versus CABG are needed and results from a large multicenter trial are forthcoming.” Lee concluded, “Unprotected left main coronary artery PCI may be a viable option for low-risk patients with normal left ventricular function.”