Left main percutaneous coronary intervention in acute and chronic coronary disease. A single center experience

Abstract

Background Improvements in percutaneous coronary intervention have reduced complications in the treatment of left main coronary artery disease. The objective of this study was to characterize percutaneous coronary intervention procedures in left main coronary artery, and evaluate patients’ outcomes. Methods A retrospective study performed from January 2015 to December 2018, in patients submitted to percutaneous coronary intervention in left main coronary artery for stable coronary artery disease or myocardial infarction, with second-generation drug-eluting stents. Results A total of 82 patients were submitted to percutaneous coronary intervention in left main coronary artery. Among them, 26.8% had stable coronary artery disease, 50% had non-ST segment elevation myocardial infarction, and 23.2% had ST segment elevation myocardial infarction. Cardiogenic shock was present in 20.7% of them. Most patients were male, elderly, with cardiovascular risk factors, namely diabetes, hypertension and hyperlipemia. Among patients with stable coronary artery disease, patients had low to intermediate SYNTAX score. During hospitalization, patients did not develop any complications. During follow-up, cardiovascular death was of 4.5% (n=1). Regarding non-ST segment elevation myocardial infarction, during hospitalization, there were no registries of events. During follow-up, 9.1% of patients had cardiovascular-related hospitalizations. A patient died (3%) during the re-hospitalization from severe heart failure. Concerning ST segment elevation myocardial infarction patients, there was one case of acute stent thrombosis during hospitalization resulting in death. One patient was readmitted for percutaneous coronary intervention in left main coronary artery due to restenosis. Regarding the patients admitted in cardiogenic shock, in-hospital mortality was 58.8%. During follow-up, two patients experienced restenosis and were hospitalized (one underwent coronary artery bypass grafting, and the other, percutaneous coronary intervention). Conclusion This is a real-world study in which we described our experience with percutaneous coronary intervention in left main coronary artery. In general, percutaneous coronary intervention in left main coronary artery in stable left main coronary artery disease, or in unstable disease with no cardiogenic shock, was a safe procedure. Further studies with extended follow-up are needed.