Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/10395
Title: Treatment of unprotected left main disease with drug-eluting stents in patients at high risk for coronary artery bypass grafting.
Authors: Barlis, Peter;Horrigan, Mark C G;Elis, Safari;Chan, Robert;Wong, Michael;Farouque, Omar;Proimos, George;Ajani, Andrew E;Clark, David J
Affiliation: Department of Cardiology, Austin Hospital, Melbourne, Victoria 3084, Australia.
Issue Date: 6-Apr-2007
Citation: Cardiovascular Revascularization Medicine : Including Molecular Interventions; 8(2): 84-9
Abstract: Percutaneous coronary intervention (PCI) for high-grade stenosis of the left main coronary artery with bare-metal stents has been limited by restenosis, and most patients are managed with coronary artery bypass grafting (CABG). Recently, drug-eluting stents (DES) have reduced instent restenosis after PCI, but their role in the treatment of left main disease remains unclear.The aim of this study was to determine the outcomes after utilizing DES to treat left main disease.Twenty consecutive symptomatic patients with >50% angiographic stenosis of the left main coronary artery with no prior history of CABG ["unprotected left main" (ULM)] underwent PCI with DES. Patients were divided into two groups based on the presence (Group A, n=5) or absence (Group B, n=15) of preprocedural cardiogenic shock. At follow up (median, 14 months), cumulative major adverse cardiac events (MACE-death, myocardial infarction, or target vessel revascularization) were determined.Sixteen (80%) of 20 patients were at high risk for CABG because of comorbidity, advanced age, or cardiogenic shock. Procedural success was 100% (20/20). Three of five patients in Group A (60%) died in hospital and the two surviving patients experienced no MACE at follow up. In Group B (n=15), there was no in-hospital MACE, but one patient died suddenly 8 weeks postprocedure [cumulative MACE of 7% (1/15)].Our study demonstrates the feasibility of ULM treatment with DES with acceptable medium-term outcomes. While CABG remains the best form of revascularization for the majority of patients with ULM, DES should be considered in those who are at high risk.
Internal ID Number: 17574165
URI: http://ahro.austin.org.au/austinjspui/handle/1/10395
DOI: 10.1016/j.carrev.2006.11.007
URL: http://www.ncbi.nlm.nih.gov/pubmed/17574165
Type: Journal Article
Subjects: Adult
Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary.adverse effects.instrumentation
Cardiovascular Agents.administration & dosage
Cardiovascular Diseases.etiology.mortality
Coronary Angiography
Coronary Artery Bypass.adverse effects
Coronary Stenosis.mortality.radiography.surgery.therapy
Feasibility Studies
Female
Follow-Up Studies
Humans
Male
Middle Aged
Patient Selection
Prospective Studies
Prosthesis Design
Research Design
Risk Assessment
Severity of Illness Index
Shock, Cardiogenic.etiology.mortality
Stents
Time Factors
Treatment Outcome
Appears in Collections:Journal articles

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