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Sivalingam J, Mazhar MW, Chaddad RA, Fouladvand F, Cortese B. Clinical outcomes of a dedicated bifurcation stent system. Cardiovasc Revasc Med 2024; 59:21-26. [PMID: 37666716 DOI: 10.1016/j.carrev.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) of bifurcation lesions is technically challenging and associated with higher rates of complications such as stent thrombosis or in-stent restenosis. In this paper, we present the clinical outcomes of BiOSS LIM C (Balton, Poland), a dedicated bifurcation stent. METHODS In this retrospective single-center study we analyzed the outcome of patients with bifurcation coronary artery disease treated with the BiOSS LIM C stent system. The primary endpoint was the cumulative rate of major adverse cardiac events (MACE) including cardiac death, myocardial infarction (MI) and target lesion revascularisation (TLR) at the longest available follow-up. RESULTS The study population consisted of 25 patients (mean age 73.6 ± 9.7 years, 25 % females). In 80 % of the cases (n = 20) BiOSS LIM C stent was implanted in the left main coronary artery. Intravascular imaging was used in 70 % of the cases and an additional regular drug-eluting stent (DES) was deployed in the side branch in 24 % of the cases. The device success rate was 100 % and we observed no in-hospital adverse events. At a median follow-up of 15 ± 6 months, the MACE rate was 56 %, cardiac death was 4 %, and clinically driven TLR was 55 %. One patient died in the LM subgroup, 5 months after the index PCI, due to NSTEMI complicated by cardiogenic shock. Two patients died due to non-cardiac causes. CONCLUSIONS In this consecutive series of patients treated with BiOSS LIM C in major coronary bifurcation lesions, mostly in the left main stem, the mid-term clinical outcomes demonstrated a high incidence of major adverse events, mainly caused by TLR, despite an adequate implantation technique.
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Affiliation(s)
- Jegan Sivalingam
- Hannah Joseph Hospital, Madurai, India; DCB Academy, Milano, Italy
| | - Muhammad Waqas Mazhar
- DCB Academy, Milano, Italy; Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Rima Ayoub Chaddad
- DCB Academy, Milano, Italy; Grand Hopital de I'Est Francilien, Marne la Valee, France
| | | | - Bernardo Cortese
- DCB Academy, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy.
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2
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Satti Z, Farag M, Egred M, Alkhalil M. Rotational atherectomy of left main stem immediately after transcatheter aortic valve implantation in a patient with symptomatic severe aortic stenosis and an impaired left ventricular systolic function: a case report. Eur Heart J Case Rep 2023; 7:ytad301. [PMID: 37470061 PMCID: PMC10353040 DOI: 10.1093/ehjcr/ytad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/09/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
Background Severe aortic stenosis (AS) and coronary artery disease (CAD) often coexist since they both share the same risk factors and pathophysiology. Patients with severe AS with prohibitive surgical risk are often treated with transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) as a staged or concurrent procedure. Significant calcified CAD and left ventricular (LV) systolic impairment in such patients would add more challenges to the management. A clear consensus on the timing of revascularization of such patients in relation to the TAVI procedure is lacking. Case summary Herein, we present an 86-year-old male who presented to a local district hospital with non-ST-segment elevation myocardial infarction (N-STEMI) and decompensated heart failure. His transthoracic echocardiography showed moderate LV systolic impairment with low-flow severe AS. He was initially treated with dual anti-platelet and diuretic therapy and subsequently underwent coronary angiography that revealed severe calcified shelf-like left main stem (LMS) and moderate left anterior descending (LAD) disease. He was successfully treated with TAVI and rotational atherectomy (RA)-assisted PCI to LMS and LAD in the same setting. Conclusion There is limited evidence on effective strategies to tackle high-risk angioplasty with concurrent TAVI in patients with impaired LV function. We performed TAVI and RA to LMS and LAD in the same setting using no mechanical circulatory support (MCS). Management strategies should be individualized to highly selected patients taking into account LMS involvement, calcium modulation strategies, haemodynamic instability, or cardiogenic shock and whether MCS is needed.
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Affiliation(s)
- Zahir Satti
- Cardiothoracic Department, Freeman Hospital, Newcastle University, Freeman Rd, Newcastle upon Tyne, NE7 7DN, UK
| | - Mohamed Farag
- Cardiothoracic Department, Freeman Hospital, Newcastle University, Freeman Rd, Newcastle upon Tyne, NE7 7DN, UK
| | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Newcastle University, Freeman Rd, Newcastle upon Tyne, NE7 7DN, UK
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Hildick-Smith D, Egred M, Banning A, Brunel P, Ferenc M, Hovasse T, Wlodarczak A, Pan M, Schmitz T, Silvestri M, Erglis A, Kretov E, Lassen JF, Chieffo A, Lefèvre T, Burzotta F, Cockburn J, Darremont O, Stankovic G, Morice MC, Louvard Y. The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN). Eur Heart J 2021; 42:3829-3839. [PMID: 34002215 DOI: 10.1093/eurheartj/ehab283] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/17/2021] [Accepted: 05/09/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with non-left-main coronary bifurcation lesions are usually best treated with a stepwise provisional approach. However, patients with true left main stem bifurcation lesions have been shown in one dedicated randomized study to benefit from systematic dual stent implantation. METHODS AND RESULTS Four hundred and sixty-seven patients with true left main stem bifurcation lesions requiring intervention were recruited to the EBC MAIN study in 11 European countries. Patients were aged 71 ± 10 years; 77% were male. Patients were randomly allocated to a stepwise layered provisional strategy (n = 230) or a systematic dual stent approach (n = 237). The primary endpoint (a composite of death, myocardial infarction, and target lesion revascularization at 12 months) occurred in 14.7% of the stepwise provisional group vs. 17.7% of the systematic dual stent group (hazard ratio 0.8, 95% confidence interval 0.5-1.3; P = 0.34). Secondary endpoints were death (3.0% vs. 4.2%, P = 0.48), myocardial infarction (10.0% vs. 10.1%, P = 0.91), target lesion revascularization (6.1% vs. 9.3%, P = 0.16), and stent thrombosis (1.7% vs. 1.3%, P = 0.90), respectively. Procedure time, X-ray dose and consumables favoured the stepwise provisional approach. Symptomatic improvement was excellent and equal in each group. CONCLUSIONS Among patients with true bifurcation left main stem stenosis requiring intervention, fewer major adverse cardiac events occurred with a stepwise layered provisional approach than with planned dual stenting, although the difference was not statistically significant. The stepwise provisional strategy should remain the default for distal left main stem bifurcation intervention. STUDY REGISTRATION http://clinicaltrials.gov NCT02497014.
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Affiliation(s)
- David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | | | | | | | - Miroslaw Ferenc
- Universitäts-Herzzentrum Bad Krozingem, Bad Krozingen, Germany
| | | | | | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | | | | | | | - Evgeny Kretov
- Sibirskiy Fеdеrаl Biomedical Research Center Novosibirsk, Novosibirsk, Russia
| | | | | | | | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Olivier Darremont
- Clinique Saint-Augustin-Elsan, 114 Avenue d'Arès, Bordeaux 33200, France
| | - Goran Stankovic
- Department of Cardiology, Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | | | - Yves Louvard
- Institute Cardiovasculaire Paris Sud, Massy, France
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4
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Hunter GW, Sharma V, Varma C, Connolly D. The EXCEL Trial: The Interventionalists' Perspective. Eur Cardiol 2021; 16:e01. [PMID: 33708262 PMCID: PMC7941379 DOI: 10.15420/ecr.2020.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
Left main stem (LMS) disease is identified in up to 5% of diagnostic angiography cases, and is associated with significant morbidity and mortality due to the proportion of myocardium it subtends. In the past 10 years, there has been a significant change in the way we contemplate treating lesions in the LMS due to evolving experience and evidence in percutaneous coronary intervention (PCI) strategies and technologies. This has been reflected in recent changes in European and International guidance on managing patients with this lesion subset. Here, the authors provide an overview of the current literature regarding the management of LMS disease using PCI in light of new developments and emerging concepts in this field, specifically looking at the recent EXCEL trial.
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Affiliation(s)
- George William Hunter
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, UK
| | - Vinoda Sharma
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, UK
| | - Chetan Varma
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, UK
| | - Derek Connolly
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, UK
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5
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Ahmad Y, Howard JP, Arnold AD, Cook CM, Prasad M, Ali ZA, Parikh MA, Kosmidou I, Francis DP, Moses JW, Leon MB, Kirtane AJ, Stone GW, Karmpaliotis D. Mortality after drug-eluting stents vs. coronary artery bypass grafting for left main coronary artery disease: a meta-analysis of randomized controlled trials. Eur Heart J 2020; 41:3228-3235. [PMID: 32118272 PMCID: PMC7557472 DOI: 10.1093/eurheartj/ehaa135] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 01/10/2023] Open
Abstract
AIMS The optimal method of revascularization for patients with left main coronary artery disease (LMCAD) is controversial. Coronary artery bypass graft surgery (CABG) has traditionally been considered the gold standard therapy, and recent randomized trials comparing CABG with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have reported conflicting outcomes. We, therefore, performed a systematic review and updated meta-analysis comparing CABG to PCI with DES for the treatment of LMCAD. METHODS AND RESULTS We systematically identified all randomized trials comparing PCI with DES vs. CABG in patients with LMCAD. The primary efficacy endpoint was all-cause mortality. Secondary endpoints included cardiac death, myocardial infarction (MI), stroke, and unplanned revascularization. All analyses were by intention-to-treat. There were five eligible trials in which 4612 patients were randomized. The weighted mean follow-up duration was 67.1 months. There were no significant differences between PCI and CABG for the risk of all-cause mortality [relative risk (RR) 1.03, 95% confidence interval (CI) 0.81-1.32; P = 0.779] or cardiac death (RR 1.03, 95% CI 0.79-1.34; P = 0.817). There were also no significant differences in the risk of stroke (RR 0.74, 95% CI 0.35-1.50; P = 0.400) or MI (RR 1.22, 95% CI 0.96-1.56; P = 0.110). Percutaneous coronary intervention was associated with an increased risk of unplanned revascularization (RR 1.73, 95% CI 1.49-2.02; P < 0.001). CONCLUSION The totality of randomized clinical trial evidence demonstrated similar long-term mortality after PCI with DES compared with CABG in patients with LMCAD. Nor were there significant differences in cardiac death, stroke, or MI between PCI and CABG. Unplanned revascularization procedures were less common after CABG compared with PCI. These findings may inform clinical decision-making between cardiologists, surgeons, and patients with LMCAD.
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Affiliation(s)
- Yousif Ahmad
- Center for Interventional Vascular Therapy, Columbia University Medical Center, NewYork–Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Ahran D Arnold
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Christopher M Cook
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Megha Prasad
- Center for Interventional Vascular Therapy, Columbia University Medical Center, NewYork–Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Ziad A Ali
- Center for Interventional Vascular Therapy, Columbia University Medical Center, NewYork–Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA
- The Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Manish A Parikh
- Center for Interventional Vascular Therapy, Columbia University Medical Center, NewYork–Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Ioanna Kosmidou
- Center for Interventional Vascular Therapy, Columbia University Medical Center, NewYork–Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA
- The Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Jeffrey W Moses
- Center for Interventional Vascular Therapy, Columbia University Medical Center, NewYork–Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA
- The Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Martin B Leon
- Center for Interventional Vascular Therapy, Columbia University Medical Center, NewYork–Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA
- The Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Ajay J Kirtane
- Center for Interventional Vascular Therapy, Columbia University Medical Center, NewYork–Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA
- The Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Gregg W Stone
- The Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, NY 10029, USA
| | - Dimitri Karmpaliotis
- Center for Interventional Vascular Therapy, Columbia University Medical Center, NewYork–Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA
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Zeitouni M, Barthelemy O, Redheuil A, Leprince P. Heart transplantation as rescue treatment of left main stem occlusion by a recurrent aortic pseudoaneurysm. Ann Cardiol Angeiol (Paris) 2019; 68:53-55. [PMID: 30149894 DOI: 10.1016/j.ancard.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/06/2018] [Indexed: 06/08/2023]
Abstract
A 58 year-old man was admitted in our ICU for cardiogenic shock and electrical storm. His medical history was marked by a triple redo valvular surgery complicated by a recurrent aortic pseudoaneurysm of the ascending aorta. Coronary angiogram and heart CT scan diagnosed an extensive anterior myocardial infarction related to an extrinsic compression of the left main stem by this massive and calcified pseudoaneurysm. Angioplasty or new cardiac surgery options were rejected by the heart team. Despite an unusual indication, the patient was registered on the heart transplant list, and underwent it successfully.
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Affiliation(s)
- M Zeitouni
- Intensive cardiovascular unit, université Paris 6, Pitié-Salpétrière hospital, institut de cardiologie, AP-HP, 13, boulevard de l'Hôpital, 75013 Paris, France.
| | - O Barthelemy
- Intensive cardiovascular unit, université Paris 6, Pitié-Salpétrière hospital, institut de cardiologie, AP-HP, 13, boulevard de l'Hôpital, 75013 Paris, France
| | - A Redheuil
- Cardiovascular and interventional radiology department, université Paris 6, Pitié-Salpétrière hospital, institut de cardiologie, AP-HP, 75013 Paris, France
| | - P Leprince
- Cardiothoracic surgery department, université Paris 6, Pitié-Salpétrière hospital, institut de cardiologie, AP-HP, 75013 Paris, France
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7
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Spinthakis N, Farag M, Gorog DA, Prasad A, Mahmood H, Gue Y, Wellsted D, Nabhan A, Srinivasan M. Percutaneous coronary intervention with drug-eluting stent versus coronary artery bypass grafting: A meta-analysis of patients with left main coronary artery disease. Int J Cardiol 2017; 249:101-106. [PMID: 28958756 DOI: 10.1016/j.ijcard.2017.09.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 08/18/2017] [Accepted: 09/15/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The relative efficacy and safety of percutaneous coronary intervention (PCI) with drug-eluting stents (DES), in comparison to coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) remains controversial. METHODS We performed a meta-analysis of randomised studies comparing patients with LMCAD treated with PCI with DES versus those treated with CABG, with respect to clinical outcomes at 1, 3 and 5years. A secondary meta-analysis was performed according to low (<32), or high (≥33) SYNTAX score. RESULTS Five studies comprising 4595 patients were included. There was no significant difference in all-cause death at all time points or when stratified with respect to SYNTAX score. The need for repeat revascularization was significantly higher with PCI at all time-points, and regardless of SYNTAX score. There was significant association between need for repeat revascularization with PCI and diabetics (p=0.04). At 5years, non-fatal MI was higher with PCI owing to increased non-procedural events (OR 3.00; CI 1.45-6.21; p=0.003). CABG showed higher rate of stroke at 1year (OR 0.21; CI 0.07-0.63; p=0.005). There was no difference in non-fatal MI or stroke at other time points, nor according to SYNTAX score. CONCLUSIONS PCI with DES or CABG are equivalent strategies for LMCAD up to 5years with respect to death, regardless of SYNTAX score. PCI increases the rate of non-procedural MI at 5years. CABG avoids the need for repeat revascularization, especially in diabetics, but this benefit is offset by higher rate of stroke in the first year of follow up.
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Affiliation(s)
- Nikolaos Spinthakis
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medical School, University of Hertfordshire, UK
| | - Mohamed Farag
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medical School, University of Hertfordshire, UK
| | - Diana A Gorog
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medical School, University of Hertfordshire, UK; National Heart & Lung Institute, Imperial College, London, UK
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Hamid Mahmood
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
| | - Ying Gue
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
| | - David Wellsted
- Postgraduate Medical School, University of Hertfordshire, UK
| | - Ashraf Nabhan
- Cochrane Advisory Group, Postgraduate Medical School, Ain Shams University, Cairo, Egypt
| | - Manivannan Srinivasan
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK.
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Hyun DY, Jeong MH, Sim DS, Jeong YA, Cho KH, Kim MC, Kim HK, Jeong HC, Park KH, Hong YJ, Kim JH, Ahn Y, Kang JC. Two-year clinical outcomes in stable angina and acute coronary syndrome after percutaneous coronary intervention of left main coronary artery disease. Korean J Intern Med 2016; 31:1084-1092. [PMID: 27756119 PMCID: PMC5094915 DOI: 10.3904/kjim.2014.373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 07/25/2015] [Accepted: 09/28/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS This study appraised the long term clinical outcomes of patients treated with percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) disease. There are limited data regarding long-term clinical outcomes after PCI for ULMCA disease. METHODS From 2001 to 2011, a total of 448 patients who underwent PCI for ULMCA disease and had 2-year clinical follow-up, were analyzed. The study patients were divided into two groups: group I (stable angina pectoris [SAP], n = 60, 48 men, 62 ± 10 years) and group II (acute coronary syndrome [ACS], n = 388, 291 men, 64 ± 10 years). We evaluated clinical and angiographic characteristics and major adverse cardiac events (MACE) during 2-year clinical follow-up. RESULTS Mean age of studied patients was 64 ± 10 years with 339 male patients. Average stent diameter was 3.6 ± 0.4 mm and stent length was 19.7 ± 6.3 mm. Stent implantation techniques and use of intravascular ultrasound guidance were not different between two groups. In-hospital mortality was 0% in group I and 7% in group II (p = 0.035). One-month mortality was 0% in group I and 7.7% in group II (p = 0.968). Two-year survival rate was 93% in the group I and 88.4% in the group II (p = 0.921). Predictive factors for 2-year MACE were hypertension, Killip class ≥ 3, and use of intra-aortic balloon pump by multivariate analysis. CONCLUSIONS Although in-hospital mortality rate was higher in ACS than in SAP, clinical outcomes during 2-year clinical follow-up were similar between SAP and ACS after PCI of ULMCA.
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Affiliation(s)
| | - Myung Ho Jeong
- Correspondence to Myung Ho Jeong, M.D. Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6243 Fax: +82-62-228-7174 E-mail:
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9
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Abstract
Significant unprotected left main stem (ULMS) disease is in approximately 5% to 7% of patients undergoing coronary angiography. Historically, coronary artery bypass grafting has been the gold standard treatment of these patients. With recent advances in stent technology, adjunctive pharmacotherapy, and operator experience, percutaneous coronary intervention (PCI) is increasingly regarded as a viable alternative treatment option, especially in patients with favorable coronary anatomy (low and intermediate SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) scores). This article aims to discuss the evidence supporting PCI for ULMS disease, current guidelines, and technical aspects.
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Affiliation(s)
- Neil Ruparelia
- Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; Department of Cardiology Imperial College, Du Cane Road, London W12 0HS, UK
| | - Alaide Chieffo
- Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
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10
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Abstract
Left main stem (LMS) disease is associated with significant morbidity and mortality. Traditionally coronary artery bypass grafting (CABG) has been the gold standard for treatment of these lesions. However over the past decade, percutaneous coronary intervention (PCI) has assumed a more prominent role in the treatment of LMS disease. With the advent of newer drug-eluting stents (DES) with an improved risk factor profile, better intravascular imaging modalities and careful patient selection, the use of PCI in this cohort is expanding. We review the current data to support this and discuss the on-going trials that will hopefully shed more light into the management of this complex disease.
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Affiliation(s)
- Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, U
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, U
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11
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Cockburn JA, Munir SM, Prendergast BD. Novel use of a guiding catheter to relieve left main stem occlusion complicating Stamford type A aortic dissection. J Cardiol Cases 2012; 6:e23-e25. [PMID: 30532940 DOI: 10.1016/j.jccase.2012.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 03/13/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022] Open
Abstract
Acute ST elevation myocardial infarction occurring as a result of acute aortic dissection is a relatively rare complication with an incidence of 1-2%. However, despite this the outcome is frequently fatal. This report documents novel use of a percutaneous guiding catheter to relieve left main stem occlusion complicating Stamford type A aortic dissection, as a bridge to successful surgical treatment. A 62-year-old man presented with acute chest pain and electrocardiographic changes consistent with acute anterior myocardial infarction, and was sent for primary percutaneous coronary intervention. Angiography demonstrated an acute Stamford type A aortic dissection with associated secondary myocardial infarction caused by mechanical obstruction of the left main coronary artery by the dissection flap. Engagement of the coronary ostium with a guide catheter relieved the obstruction and allowed transfer of the patient to the operating theatre where surgery was successfully performed.
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Affiliation(s)
- James A Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Shahzad M Munir
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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12
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Lee JH, Seo SM, Kim EO, Ahn HJ, Lee YW, Cho YH, Baek I, Oh YS, Yu J, Seung KB. Stent fracture at the proximal shaft of the left main stem. Korean Circ J 2012; 41:763-5. [PMID: 22259610 PMCID: PMC3257463 DOI: 10.4070/kcj.2011.41.12.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 03/08/2011] [Accepted: 03/22/2011] [Indexed: 11/11/2022] Open
Abstract
Stent fracture is likely to be caused due to mechanical stress at the hinge point or kinking movement at the point of aneurysm formation with stent malapposition. To our knowledge, this is the first published report of stent fracture at the proximal shaft of the left main stem in a patient with acute myocardial infarction.
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Affiliation(s)
- Jae Ho Lee
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hertting K, Härle T, Krause K, Reimers J, Boczor S, Kuck KH. Stenting of unprotected left main stem stenosis: Results from a German single-centre registry. Exp Clin Cardiol 2008; 13:37-41. [PMID: 18650971 PMCID: PMC2435394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Accepted: 10/26/2007] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To elucidate the influence of drug-eluting stents (DESs) on interventional therapy of de novo unprotected left main stem (LMS) lesions in a hospital with on-site cardiac surgery. METHODS AND RESULTS A retrospective study of all patients with unprotected LMS angioplasty from 1999 to 2005 was conducted with regard to clinical and procedural data, and follow-up data. Fifty-four patients with unprotected LMS stenosis were treated inter-ventionally. Of these patients, 16 were treated with DESs. Seven patients presented with cardiogenic shock. During their hospital stay, four patients died (all treated with bare metal stents [BMSs], three initially presenting with cardiogenic shock). Follow-up data for 53 patients (98%) were obtained. Median follow-up time was 24 months (25th percentile, 12 months; 75th percentile, 35 months). Survival after nine months was 87% (81% from the BMS-treated group, and 100% from the DES-treated group). Control angiography had been performed in 36 patients (67%). Patients with unprotected LMS with an angiographic follow-up had a higher nine-month survival rate than patients without (36 of 36 patients [100%] versus 10 of 17 patients [59%], respectively; P<0.0001). Target lesion revascularization rate was 19% in both the BMS and the DES groups. Methods of revascularization did not vary significantly between the groups. CONCLUSIONS In the present study of selected patients with LMS stenosis, the use of DESs showed a low mortality rate but did not have a clear effect on target lesion revascularization rate compared with BMSs. A close follow-up appears to be mandatory to achieve acceptable results.
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Affiliation(s)
- Klaus Hertting
- Correspondence: Dr Klaus Hertting, Asklepios Klinik St Georg, Department of Cardiology, Lohmuehlenstrasse 5, 20099 Hamburg, Germany. Telephone 49-40-181885-2305, fax 49-40-181885-4444, e-mail
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