[Percutaneous intervention in left main coronary disease: medium and long term clinical outcomes in a high risk population].

Purpose: Coronary artery bypass graft (CABG) remains the standard therapy for left main coronary artery (LMCA) disease.However, in recent years, percutaneous coronary intervention (PCI) has shown good results and is being used in an increasing number of patients. We aimed to assess mid and long term clinical outcomes of patients undergoing LMCA PCI in a hospital with cardiac surgery.

Methods: Retrospective analysis of consecutive patients undergoing LMCA PCI between January 2005 and June 2011.F our groups (G) of indications for PCI were defined: G1 - patients refused for surgery (29.2%), G2 - emergent PCI (14.6%),G3 - PCI of protected LMCA (37.5%) and G4 - LMCA PCI as preferred revascularization strategy due to favorable coronary anatomy (18.8%).

Results: Ninety-six patients were treated, mostly male (69.8%), mean age of 69.4±10.5 years. Most patients (69%) had acute coronary syndrome and 14% were in cardiogenic shock. Critical stenosis of distal LMCA was seen in 58% and drug-eluting stents were used in 60%. Mean logistic EuroScore was 13.9±11.9%. Patients from groups 1, 2 and 3 had more multivessel disease (96, 79 and 89%, respectively) than those from G4 (isolated LMCA disease in 58%). Follow-up was performed in 100% of patients (median of 21 months; IQR 10.0 - 43.5), with a total mortality rate of 28.1% (14.6% of cardiovascular (CV) causes). Seven patients (7.3%) had in-hospital death. MACCE rate (CV death, nonfatal myocardial infarction, stroke and LMCA reintervention) was 26% and one-year mortality was 15.4%. Five patients (5.6%) required percutaneous reintervention; CABG was performed only in 1 patient.In subgroup analysis it was found that total mortality in G1 and G2 (46.4% and 64.3%) was significantly higher than that of G3 and G4 (11.1% and 5.6% respectively), p <0.001. The same trend was observed for CV mortality: G1 (25.0%) and G2 (35.7%) vs G3 (5.6%) and G4 (0%), p = 0.005.

Conclusion: LMCA PCI proved to be a safe technique with low mortality in patients with protected LMCA and those with favorable coronary anatomy for percutaneous revascularization. Patients undergoing emergent PCI or refused for surgery had a large number of events, according to their very high baseline risk profile.