Search

Introduction and Objectives: Percutaneous coronary intervention is recommended in patients with unprotected left main stenosis non suitable for coronary artery bypass graft. Long-term follow-up of those patients remains uncertain., Methods: All patients with de novo unprotected left main stenosis treated with stent implantation were consecutively enrolled. Percutaneous coronary intervention was indicated according to the standards of care, taking into account clinical and anatomical conditions unfavorable for coronary artery bypass graft. The primary end point was the occurrence of major adverse cardiac events, a composite of death, nonfatal acute myocardial infarction, or target lesion revascularization., Results: Of 226 consecutive patients included, 202 (89.4%) were treated with drug-eluting stents. Mean age was 72.1 years, 41.1% had renal dysfunction, and mean Syntax score and EuroSCORE were 28.9 and 7.4, respectively. Angiographic and procedural success was achieved in 99.6% and 92.9% of patients. At 3 years, the rates of major adverse cardiac events, death, nonfatal acute myocardial infarction and target lesion revascularization were 36.2%, 25.2%, 8.4%, 8.0%, respectively. Target lesion revascularization was more frequently observed when ≥ 2 stents were implanted rather than a single stent (18.5% vs 5.8%, P=.03); and with bare metal stents rather than drug-eluting stents (13.0% vs 7.9%, P=.24). Definite stent thrombosis was observed in 2 patients (0.9%) and probable stent thrombosis in 7 (3.1%). Female sex, impaired left ventricular function, and use of bare metal stents were significantly related with all-cause mortality., Conclusions: High-risk patients with unprotected left main stenosis treated with percutaneous coronary intervention presented with a high rate of major adverse cardiac events at long-term follow-up. Female sex, impaired left ventricular function, and use of bare metal stents were predictors of poor prognosis., (Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Although drug-eluting stents have reduced the restenosis rate, some patients are not good candidates for prolonged double-antiplatelet therapy. Our goal was to learn the results of implanting cobalt-chromium stents in long lesions of large vessels.All consecutive patients with ≥1 lesion treated with a cobalt-chromium stent ≥28 mm in length and ≥3.5 mm in diameter during a 12-month period in 2 centers were monitored clinically and angiographically to determine the clinical status, restenosis rate, pattern of restenosis, and need for revascularization.The series comprised 78 patients with 81 lesions, mean age, 62.6 ± 15.2 yr; diabetes mellitus,19.2%; and primary or rescue intervention, 20.6%. Target vessels were the left anterior descending coronary artery, 12 (14.8%); left circumflex coronary artery, 12 (14.8%); and right coronary artery, 57 (70.4%). The mean lesion length was 35.18 ± 12.65 mm. The proximal reference diameter after percutaneous coronary intervention was 3.64 ± 0.54 mm; the distal, 3.2 ± 0.43 mm; and the mean, 3.42 ± 0.44 mm. The mean stent length was 38.05 ± 12.78 mm (range, 28-90 mm). The binary restenosis rate was 23% (15/64), with pattern IB in 2 cases, IC in 5, II in 7, and IV in 1. Revascularization was needed in 6 patients.In treating long lesions of large vessels, we found that cobalt-chromium stents achieved a moderate rate of target-vessel restenosis and a low rate of repeat revascularization. The pattern of restenosis was focal in almost half of the cases, and, in most remaining cases, restenosis affected short segments of the vessel.