Angioplasty of the left main coronary artery: Mid-term follow-up at University Medical Centre Groningen.

Abstract Background Coronary angioplasty is being increasingly performed in complex lesions of the unprotected and protected left main (LM) coronary artery. Objectives To assess the impact of patient and operator related clinical variables of success and to evaluate the subsequent mid-term effects of percutaneous treatment of LM coronary stenosis. Methods In a tertiary referral, high-volume angioplasty centre a total of 118 consecutive surgical and nonsurgical patients with protected and unprotected LM lesions were treated and evaluated in a retrospective observational study. Results There were 57 protected and 61 unprotected patients, including 13 patients with an acute myocardial infarction (AMI). Mean age was 67 years (range 33-90). The length of the stenotic segment was 4.8±2.3 mm, mean lumen diameter 1.1±0.6 mm and percentage diameter stenosis 63.6±14.6%. There were seven (5.9%) in-hospital cardiac deaths which presented with AMI and cardiogenic shock. All seven patients had unprotected LM lesions. Average follow-up was eight months (range 1 to 36 months). Major adverse cardiac events (MACE) during follow-up comprised eight (6.8%) cardiac deaths, three (2.5%) myocardial infarctions, eight (6.8%) subjects with coronary bypass surgery and 16 (13.6%) repeated angioplasties. The total event rate (MACE, n=43) at the end of the follow-up period was 36.4%. There were more MACE in the unprotected group than in the protected group (41 vs. 31.6%, p<0.05). Conclusion This study supports prior data on LM angioplasty. LM stenting in AMI, however, showed less favourable in-hospital and late outcome.