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Background: According to the American College of Cardiology/American Heart Association guidelines, percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) stenosis is contraindicated and coronary artery bypass graft surgery (CABG) is preferred. However, PCI of the LMCA is performed under exceptional circumstances.Objective: To analyse the data of patients who underwent PCI of the unprotected LMCA in St Antonius Hospital, Nieuwegein, Netherlands.Results: In a database of 17 683 PCI procedures, 71 patients (0.4%) were found with non-bifurcational LMCA stenosis who underwent an elective PCI between 1991 and 2001. Ages ranged from 26.7-86.5 years. Severe concomitant disease was the most frequent argument in favour of PCI instead of CABG. PCI consisted of only balloon angioplasty in 23 cases (32.4%). A stent was used in 46 cases (64.4%). Average follow up was 43 months (range 0-121 months). One patient died one day after the procedure. The total one year survival rate was 98.6% (70/71). Seven patients died during the follow up period, mostly because of non-cardiac reasons. The annual mortality rate was 2.5%. Recurrent elective percutaneous transluminal coronary angioplasty for restenosis of the LMCA was performed in one patient (1.4%) six weeks after the initial procedure. CABG was required in 13 patients (18.3%) throughout the follow up period.Conclusion: These results suggest that at highly experienced centres, elective PCI of the non-bifurcational LMCA can be performed safely where the anatomy is suitable. [ABSTRACT FROM AUTHOR]

Acute occlusion of the unprotected left main coronary artery (LMCA) is fatal in most cases. The life of the patient can be saved by the rapid reperfusion of the occluded LMCA by means of catheter intervention. Emergency PCI of the unprotected LMCA was performed in 35 cases, representing 0.2% of the 17 683 patients who underwent PCI at the centre between January 1990 and July 2001. Twenty six of the study patients were being treated in the setting of acute myocardial infarction Generally, PCI is a safe and effective treatment for most significant coronary stenoses. An exception is PCI of the LMCA, which is not practised routinely, as balloon induced dissection of the LMCA may result in an immediately life threatening condition.