Percutaneous Coronary Artery Stenting of Unprotected Left Main Coronary Artery Disease Using Drug-Eluting Stents: The Initial Baylor University Medical Center Experience

Garner, William Lance; Stoler, Robert C.; Laible, Emily; Kang, Minho; Choi, James W.

doi:10.1080/08998280.2007.11928317

Cited by 4 publications

(3 citation statements)

References 29 publications

(27 reference statements)

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“…Medical treatment of LM disease has unacceptably high mortality rates. 7 , 21 Early observational studies demonstrated that long-term prognoses of patients with medically treated LMCA disease were poor, with 3-year survival rates of 50%. 11 …”

Section: Discussionmentioning

confidence: 99%

“… 1 - 4 Critical LMCA stenosis puts patients at high risk of cardiovascular events because of the extent of jeopardized myocardium and associated multi-vessel coronary artery disease and, therefore, it has been considered as the most important coronary lesion in terms of prognosis. Current practice guidelines suggest coronary artery bypass grafting (CABG) as the standard procedure for patients with unprotected LMCA disease 5 - 7 primarily because long-term outcomes of surgical revascularization are superior to those of medical treatment. 8 - 10 However, because of anatomic accessibility and other characteristics, percutaneous coronary intervention (PCI) for LMCA disease was attractive to the interventional cardiologist, and data from several archives showed its feasibility and short and midterm effectiveness.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Technical Success of Percutaneous Left Main Coronary Artery Stenting

Malik¹,

Khalid²,

Sultan³

et al. 2014

Pak J Med Sci

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Objective: Critical stenosis of left main coronary artery (LMCA) has always remained a challenge for interventional cardiologists. Conventionally Coronary Artery Bypass Grafting (CABG) is done for these patients but recently Percutaneous Coronary Intervention (PCI) is also being tried more frequently, but data of PCI is scarce in this regard. Our objective was to determine the safety and technical success rate of percutaneous left main coronary artery stenting. Methods: This was 12 month follow up study conducted at Pakistan Institute of Medical Sciences (PIMS), Islamabad from 11th Jan 2012 to 11th Jan 2013. All symptomatic patients who underwent coronary angiogram at PIMS and were found to have either isolated LMCA disease or coexisting osteal Left Anterior Descending (LAD) artery disease were potentially eligible for the study. Patients who had previous surgical treatment for coronary artery disease and those with renal dysfunction requiring dialysis were excluded. Patients were counselled in detail regarding the pros and cons of PCI versus CABG.Those who opted for PCI were included in the study. All these patients were treated with percutaneous left main coronary artery stenting with or without osteal LAD stenting. Results: Seventy two patients had LMCA disease during angiogram. Fifteen patients opted for CABG. Four patients did not meet the inclusion criteria, whereas 53 patients were finally enrolled. Mean age of patients were 55.45±10.275 years. Twenty nine patients were with acute coronary syndrome and 22 presented with unstable angina.PCI with stenting was technically successful in all patients. One patient died three months after PCI, there was no other mortality. Conclusion: Our study showed that Percutaneous Coronary Intervention (PCI) to LMS has good technical success rate; the safety of the procedure is also acceptable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety and Technical Success of Percutaneous Left Main Coronary Artery Stenting

Malik¹,

Khalid²,

Sultan³

et al. 2014

Pak J Med Sci

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“…One such form of ACS that presents a life‐threatening situation is unprotected left main coronary artery (ULMCA) stenosis. Without revascularization treatment, patients with ULMCA disease face a 3‐year mortality rate of nearly 50% (Garner, Stoler, Laible, Kang, & Choi, ). Coronary artery bypass grafting (CABG) surgery has long been considered the gold standard for revascularization in patients with significant ULMCA disease (Kushner et al., ).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of coronary artery interventions: Comparing coronary artery bypass surgery and percutaneous coronary intervention in patients with unprotected left main stenosis

Crouse¹,

Kitko²

2014

Journal of the American Association of Nurse Practitioners

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Purpose The purpose of this integrative review is to examine the existing literature comparing short‐ and long‐term outcomes of both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with unprotected left main coronary artery (ULMCA) stenosis. CABG has long been considered the standard of treatment for ULMCA stenosis; however, advancements in the use of PCI have made it a viable alternative treatment option. Data sources Sixteen articles were selected from a literature search using the PubMed database, with at least 1 year of follow‐up and adjustment for established risk factors. Conclusions The majority of studies found CABG and PCI with stenting to be comparable and equally safe treatment strategies for patients with ULMCA stenosis. Some studies found that PCI had a significantly lower risk for adverse events and mortality compared to CABG. However, a large number of studies found that PCI had a higher rate of target vessel restenosis. Implications for practice Advanced practice nurses have become a prominent and influential part of the healthcare delivery system. As such, advanced practice nurses should be educated on the current research about coronary artery interventions so that they may better screen, treat, and manage this patient population.

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Coronary Artery Bypass Graft Surgery vs Percutaneous Interventions in Coronary Revascularization

Deb¹,

Wijeysundera²,

Ko³

et al. 2013

JAMA

251

136

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IMPORTANCE Ischemic heart disease is the leading cause of death globally. Coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) are the revascularization options for ischemic heart disease. However, the choice of the most appropriate revascularization modality is controversial in some patient subgroups. OBJECTIVE To summarize the current evidence comparing the effectiveness of CABG surgery and PCI in patients with unprotected left main disease (ULMD, in which there is >50% left main coronary stenosis without protective bypass grafts), multivessel coronary artery disease (CAD), diabetes, or left ventricular dysfunction (LVD). EVIDENCE REVIEW A search of OvidSP MEDLINE, EMBASE, and Cochrane databases between January 2007 and June 2013, limited to randomized clinical trials (RCTs) and meta-analysis of trials and/or observational studies comparing CABG surgery with PCI was performed. Bibliographies of relevant studies were also searched. Mortality and major adverse cardiac and cerebrovascular events (MACCE, defined as all-cause mortality, myocardial infarction, stroke, and repeat revascularization) were reported wherever possible. FINDINGS Thirteen RCTs and 5 meta-analyses were included. CABG surgery should be recommended in patients with ULMD, multivessel CAD, or LVD, if the severity of coronary disease is deemed to be complex (SYNTAX >22) due to lower cardiac events associated with CABG surgery. In cases in which coronary disease is less complex (SYNTAX Յ22) and/or the patient is a higher surgical risk, PCI should be considered. For patients with diabetes and multivessel CAD, CABG surgery should be recommended as standard therapy irrespective of the severity of coronary anatomy, given improved long-term survival and lower cardiac events (5-year MACCE, 18.7% for CABG surgery vs 26.6% for PCI; P = .005). Overall, the incidence of repeat revascularization is higher after PCI, whereas stroke is higher after CABG surgery. Current literature emphasizes the importance of a heart-team approach that should consider coronary anatomy, patient characteristics, and local expertise in revascularization options. Literature pertaining to revascularization options in LVD is scarce predominantly due to LVD being an exclusion factor in most studies. CONCLUSIONS AND RELEVANCE Both CABG surgery and PCI are reasonable options for patients with advanced CAD. Patients with diabetes generally have better outcomes with CABG surgery than PCI. In cases of ULMD, multivessel CAD, or LVD, CABG surgery should be favored in patients with complex coronary lesions and anatomy and PCI in less complicated coronary disease or deemed a high surgical risk. A heart-team approach should evaluate coronary disease complexity, patient comorbidities, patient preferences, and local expertise.

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Percutaneous Coronary Artery Stenting of Unprotected Left Main Coronary Artery Disease Using Drug-Eluting Stents: The Initial Baylor University Medical Center Experience

Cited by 4 publications

References 29 publications

Safety and Technical Success of Percutaneous Left Main Coronary Artery Stenting

Safety and Technical Success of Percutaneous Left Main Coronary Artery Stenting

Outcomes of coronary artery interventions: Comparing coronary artery bypass surgery and percutaneous coronary intervention in patients with unprotected left main stenosis

Coronary Artery Bypass Graft Surgery vs Percutaneous Interventions in Coronary Revascularization

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