Initial and long-term results of angioplasty in unprotected left main coronary artery

Angioplasty of the unprotected left main coronary artery (LMCA) has been co ntroversial. Although recent single-center studies suggest that new devices may change the situation, many questions and problems remain. Therefore, t he results of unprotected left main coronary angioplasty of 175 procedures in 107 patients were analyzed to evaluate its feasibility and effectiveness . The treatment of the initial 107 cases included balloon angioplasty (39 c ases, 36%), directional coronary atherectomy (53 cases, 50%), and scents (1 5 cases, 14%). They were divided into 3 major subgroups: (1) acute group (n = 14), in which LMCA angioplasty was performed in patients with acute myoc ardial infarction; (2) emergency group (n = 10); and (3) elective group (n = 83). In-hospital mortality was higher in the acute (35.7%) and emergency (40.0%) groups than in the elective group (3.6%; p <0.0001). Angiographic f ollow-up was routinely performed and the restenosis rate including in-hospi tal restenosis was 70% in the acute group, 37.5% in the emergency group, an d 40% in the elective group (p = NS). The mean clinical follow-up period wa s 2.9 years, and the estimated 5-year survival rates of the acute and emerg ency groups were 50% and 48.2%, respectively. However the 5-year survival r ate of the elective group was higher than that seen in the acute or emergen cy group (77.5%.; p <0.05). Repeat LMCA angioplasty was performed In 37 of 68 patients with 8.8% mortality (38.5% of acute and emergency cases and 1.8 % of elective cases). The results indicated that elective unprotected LMCA angioplasty is relatively feasible and effective under scheduled angiograph ic follow-up. (C)1999 by Excerpta Medica, Inc.