Key result
Stenting of the unprotected left main coronary artery without intravascular ultrasound was associated with a 13.3% complication rate at 6 months, which significantly correlated with baseline LVEF <40% and higher SYNTAX scores.
Why the study?
While IVUS has improved unprotected left main stenting results, outcomes of stenting unprotected left main disease without new imaging modalities but with meticulous care needed further study.
Does percutaneous coronary intervention with drug-eluting stents without IVUS guidance provide safe outcomes in patients with unprotected left main coronary artery disease?
Cohort (n=120)
Yes
Does percutaneous coronary intervention with drug-eluting stents without IVUS guidance provide safe outcomes in patients with unprotected left main coronary artery disease?
PCI for unprotected left main coronary artery disease without IVUS guidance is feasible and safe, with outcomes strongly dependent on baseline LVEF and SYNTAX score.
May warrant caution with low LVEF or high SYNTAX in unprotected LM PCI without IVUS; leaves open prospective trials of imaging guidance.
Background New imaging modalities such as IVUS had improved results of stenting of the unprotected left main coronary artery (UPLM). The results of stenting UPLM without these new modalities but with meticulous care need to be studied more. Methods We analyzed data from 120 patients with UPLMD of > 50% subjected to stenting. All were stented by drug-eluting stents and followed for six months. Results 92 patients (77.3%) presented with ACS, of which 65 patients (54.6%) had no Previous Intervention, and 27 patients (22.7%) had a previous PCI. Left ventricular ejection fraction significantly correlates with complication, at 6 months follow up; all 16 patients with reported complications (100%) had baseline LVEF of < 40% (P-value = 0.023). Syntax score: 11 patients (55%) with a high score of more than 32 had adverse events, P = 0.004. Residual syntax shows a less significant correlation with a mean value of 7.3 in the complication group versus 4.9 in the other group (P = 0.016). Final kissing balloon inflation shows no statistically significant difference. Conclusions PCI in UPLM is a safe, feasible option with a high technical success rate and acceptable outcome at follow-up even without the utilization of IVUS
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Rafla et al. (2022) conducted a cohort in Unprotected left main coronary artery disease (n=120). Drug-eluting stenting without intravascular ultrasound was evaluated on Major cardiovascular events at 30 days and 6 months (death, myocardial infarction, cerebrovascular stroke, and re-intervention). Stenting of the unprotected left main coronary artery without intravascular ultrasound was associated with a 13.3% complication rate at 6 months, which significantly correlated with baseline LVEF <40% and higher SYNTAX scores.
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