Long-term Outcome of Stenting of Left Main Coronary Artery Stenosis Favorable

In patients with preserved left ventricular function, stenting of unprotected left main coronary artery (LMCA) stenosis offers favorable outcomes at 3 years, according to a report in the January issue of The American Journal of Cardiology.

Previous studies have suggested a role for stenting of unprotected LMCA stenosis, the authors explain, but there is little information about long-term outcomes in such patients.

Dr. Seung-Jung Park from the University of Ulsan in Seoul, Korea and colleagues examined the long-term safety and effectiveness of stenting in 270 patients with unprotected LMCA stenosis and normal left ventricular function.

The procedural success rate exceeded 98%, the authors report, and while there were 3 emergency bypass surgeries and 1 repeat coronary intervention, there were no in-hospital deaths.

At angiographic follow-up, the restenosis rate was 21.1%, with initial stenosis size being the only independent predictive factor. Thirty-nine of the 50 restenoses occurred within the stents.

During the mean follow-up period of 32.3 months, the researchers note, 20 patients died, 8 of them from cardiac causes. Advanced age and the presence of other combined coronary arterial disease significantly predicted an increased risk of death.

According to the results, there were five nonfatal myocardial infarctions and 45 repeat revascularizations of the affected LMCA during follow-up. Most such events occurred within the first 6 months. Beyond 6 months, the need for revascularization was more likely to be associated with another lesion.

The 3-year overall survival rate was 92.1%, the report indicates, and the 3-year major adverse coronary event (MACE)-free survival rate was 77.7%.

“These results indicate that the clinical course after stenting of unprotected LMCA stenosis is similar to that of non-LMCA intervention, and provides a rationale for this strategy,” the authors conclude. “However, extra caution may be warranted for patients with impaired left ventricular function and unstable symptoms for whom bypass surgery should be considered the standard treatment.”