In-Hospital and Mid-Term Outcomes of Stent Implantation in Patients with Protected and Unprotected Left Main Coronary Artery Disease; King Chulalongkorn Memorial Hospital Experiences
Jiranut Cholteesupachai MD*, Wasan Udayachalerm MD*, Suphot Srimahachota MD*, Wacin Buddhari MD*, Jarkarpun Chaipromprasit MD*, Smonporn Boonyaratavej Songmuang MD**, Taworn Suithichaiyakul MD**
Affiliation : * Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand ** Division of Cardiology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Background : Left Main Coronary Artery (LMCA) disease is now uniformly treated with coronary artery by
pass grafting (CABG). However, some patients with LMCA disease did not receive CABG because of high
operative risks as well as those who refused CABG. Recent studies demonstrated the feasibility of stenting for
LM stenosis, although data remain limited.
Objective : To evaluate in-hospital and mid-term outcomes of using bare metal stent (BMS) and drug eluting
stent (DES) in protected and unprotected left main coronary artery disease at King Chulalongkorn Memorial
Hospital.
Material and Method: Retrospective, single-center study. The authors reviewed the outcomes of patients who
underwent percutaneous coronary intervention on left main coronary artery lesions in our hospital from July
2000 to August 2007. In-hospital data and clinical follow-up outcomes were analyzed and determined as
in-hospital and mid-term mortality, major adverse cardiac event (MACE).
Results : In eight years the authors reviewed 64 consecutive protected and unprotected LMCA patients who
underwent PCI with stent placement. Altogether left main coronary artery stents were successfully deployed in
all patients. DES usage was 64%. Bifurcation technique for distal left main coronary artery was executed in 32
patients (50%), included single stent in 62 (97%), two stents in 2(3%). Final kissing ballon inflation was
done in 14 (21.9%). In-hospital mortality was 4.7% (three patients), two patients died from cardiac origin.
The total in-hospital major adverse cardiac event (MACE) was 4.7%. Clinical follow-up of 6 months was
completed in 100% of patients. Fifty percent of patients had angiographic follow-up and in-stent restenosis
rate was 9.7%. No further death was noted and MACE at 6 months was 9.4%. Moreover, overall mean and
median follow-up period were 31 + 25 months (range, 6-93 months) and 26 months respectively.
Conclusion : Stent Implantation was technically feasible and safely applied for the treatment of protected and
unprotected left main coronary artery lesions in patients, with acceptable in-hospital and mid-term outcomes.
More randomized and controlled clinical trials are needed to confirm the long-term effects of stents for LMCA
disease.
Keywords : Coronary artery disease, Coronary stenosis, Drug-eluting stents, Prostheses and implants, Prosthesis implantation, Stents
