Pericatheterization risk factors in left main coronary artery stenosis

Gordon, Pamela R.; Abrams, Cyril; Gash, Arnold K.; Carabello, Blasé A.

doi:10.1016/0002-9149(87)90852-6

Cited by 25 publications

(10 citation statements)

References 22 publications

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“…16 In a study by Gordon et al, there was a 24% complication rate when the catheter tip was 6 mm or less from the lesion compared to a 3% complication rate when the catheter tip was more than 6 mm from the lesion. 17 This confirms the notion that the complication rate from diagnostic angiography is higher with ostial LMCA stenosis, and certain procedural precautions need to be followed. Potential complications relate to contrast-induced diuresis and the hemodynamic effects of contrast agents.…”

Section: Etiologysupporting

confidence: 75%

“…There is at least a >2‐fold higher risk of complications after coronary angiography with significant LMCA stenosis 16 . In a study by Gordon et al, there was a 24% complication rate when the catheter tip was 6 mm or less from the lesion compared to a 3% complication rate when the catheter tip was more than 6 mm from the lesion 17 . This confirms the notion that the complication rate from diagnostic angiography is higher with ostial LMCA stenosis, and certain procedural precautions need to be followed.…”

Section: Diagnostic Angiographymentioning

confidence: 99%

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Percutaneous Intervention of Unprotected Left Main Coronary Artery

Sadeghi

O’Neill

Grines

2003

J Interven Cardiology

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Successful percutaneous intervention of unprotected left main coronary artery (LMCA) in lieu of surgical revascularization represents the next wave of challenges that the field of interventional cardiology will try to overcome. Significant LMCA stenosis, commonly secondary to atherosclerosis, is seen in about 4-10% of cases presenting to the cardiac catheterization laboratory. Currently, the vast majority of these patients undergo surgical revascularization unless there are prohibitive reasons for surgical revascularization. Several challenges of percutaneous revascularization have been overcome with stents, intravascular brachytherapy, and other technical improvements. Yet, several remaining limitations of percutaneous intervention, such as in-stent restenosis, have to be improved further before randomized clinical trials of surgical and percutaneous revascularization of unprotected LMCA disease can be contemplated to establish a new standard of care.

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Section: Etiologysupporting

confidence: 75%

Section: Diagnostic Angiographymentioning

confidence: 99%

Percutaneous Intervention of Unprotected Left Main Coronary Artery

Sadeghi

O’Neill

Grines

2003

J Interven Cardiology

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“…Cinecoronary arteriography in the presence of a left main coronary artery lesion is a procedure with a high risk of complication [9][10][11] ; however, no complication was observed in the population studied.…”

Section: Methodsmentioning

confidence: 99%

Can patients with left main coronary artery disease wait for myocardial revascularization surgery?

Rocha

Silva

2003

Arq. Bras. Cardiol.

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or = 50%) consecutively identified on diagnostic cardiac catheterization during an 8-month period were selected for the study. The group comprised 56 patients (40 males and 16 females) with a mean age of 61±10 years. The cardiac events included death, nonfatal acute myocardial infarction, acute left ventricular failure, unstable angina, and emergency surgery. RESULTS: While waiting for surgery, patients experienced the following cardiac events: 7 acute myocardial infarctions and 1 death. All events occurred within the first 60 days after the diagnostic cardiac catheterization. More patients, whose indication for diagnostic cardiac catheterization was unstable angina, experienced events as compared with those with other indications [p=0.03, relative risk (RR) = 5.25, 95% confidence interval = 1.47 - 18.7]. In the multivariate analysis of logistic regression, unstable angina was also the only factor that independently contributed to a greater number of events (p = 0.02, OR = 8.43, 95% CI =1.37 - 51.7). CONCLUSION: Unstable angina in patients with left main coronary artery disease acts as a high risk factor for cardiac events, emergency surgery being recommended in these cases.]]>

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“…Stenosis of more than 50% in the left main coronary artery (LMCA) is an important manifestation of coronary artery disease and is known to be associated with high rate of complications during and after coronary angiography (Gordon et al 1987;Ko et al 1991;Morton et al 1993). Most centers, when diagnose LMCA stenosis, give priority to those patients for surgery.…”

Section: Study Protocolmentioning

confidence: 99%

Preoperative Clinical Status but not Waiting Time Predicts In-Hospital Outcomes of Surgery in Patients with Left Main Coronary Artery Stenosis

Sarı

Acar

Nurkalem

et al. 2007

Tohoku J. Exp. Med.

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Contoversy exists about the optimal operation time of the patients with left main coronary artery (LMCA) stenosis. We therefore, aimed to investigate the effect of waiting time on in-hospital morbidity and mortality in patients with LMCA stenosis and identify the risk factors associated with adverse cardiovascular events before and during surgery. One hundred seventy six patients with LMCA stenosis were divided into two groups according to the time period between coronary angiography and coronary artery bypass surgery (group 1: 7 days, 94 patients; and group 2: > 7 days, 82 patients). Primary end points were death and major adverse cardiac event (MACE): in-hospital death, sustained ventricular tachycardia or ventricular fibrillation development, postoperative stay in the intensive care > 48 hrs and in hospital > 9 days. Demographic and clinical characteristics of patients in groups 1 and 2 were comparable. There was no difference between the two groups in terms of in-hospital morbidity, mortality and MACE. When we analyzed the differences between the patients with and without MACE, the patients who experienced MACE were older ( p = 0.001), and had higher degree of LMCA stenosis ( p = 0.01), higher degree of right coronary artery stenosis ( p = 0.02), higher blood urea level ( p = 0.003), and higher incidence of unstable angina or myocardial infarction within 2 weeks ( p = 0.001). Independent risk factors for MACE were unstable angina or myocardial infarction within 2 weeks, age more than 70 years and stenosis more than 75% in the LMCA. These results suggest that preoperative clinical status but not waiting time predicts in-hospital surgical outcomes in LMCA stenosis.left main coronary artery stenosis; surgery; waiting time

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Pericatheterization risk factors in left main coronary artery stenosis

Cited by 25 publications

References 22 publications

Percutaneous Intervention of Unprotected Left Main Coronary Artery

Percutaneous Intervention of Unprotected Left Main Coronary Artery

Can patients with left main coronary artery disease wait for myocardial revascularization surgery?

Preoperative Clinical Status but not Waiting Time Predicts In-Hospital Outcomes of Surgery in Patients with Left Main Coronary Artery Stenosis

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