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Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients

Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients,10.1016/S1062-1458(02)00558-5,Acc Current

Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients   (Citations: 52)
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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. (Circulation. 2001;104:1609-1614.)
Journal: Acc Current Journal Review , vol. 11, no. 2, pp. 55-55, 2002
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    • ... Although stenting of unprotected LMCA lesions is feasible and appears to be a promising strategy in selected patients, the use of this technique is hampered by the occurrence of distal lesion bifurcation and stent restenosis, which can be fatal...

    Alaide Chieffoet al. Treatment of unprotected left main coronary artery disease with drug-e...

    • ...But more recent advances in procedural techniques, devices, medication, patient selection and the operators’ experience has improved outcomes, made PCI an attractive alternative to CABG(5-12)...
    • ...Fig. 2 MACE-free survival rate at mid-term clinical follow-up that in-hospital cardiac mortality rate for elective procedures ranged from 0-4%, but it increased to 13.7% when emergency PCI for AMI patients was included(6)...
    • ...The long-term outcomes of clinical and angiographic follow-up for this group of patients seem to be similar to other previous reports(6, 9,10)...

    Jiranut Cholteesupachaiet al. In-Hospital and MidTerm Outcomes of Stent Implantation in Patients wit...

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