Percutaneous coronary interventions of unprotected left main stenosis

Significant stenosis of the trunk of the left coronary artery (LCA) or left main (LM) stenosis is a serious injury that puts a large myocardial area at risk, being found in 4-9% of patients referred for selective coronary angiography. Revascularization in patients with severe left main stenosis significantly improves their prognosis, with bypass surgery being the standard of care. Percutaneous coronary intervention (PCI) has proven to be an effective and safe alternative, especially in patients with less complex lesions or unsuitable for surgery. The aim of this article is to review the topic and to analyze the frequency of adverse cardiovascular events in a two-year follow-up of patients with PCI of unprotected LM stenosis from real practice. Material and methods: Since March 2013, all patients with an interventional procedure for LM stenosis in the Cardiology Clinic of Acibadem City Clinic Tokuda Hospital are included in a register. For the period from 06.2013 to 06.2018, 209 PCIs of LM lesions were performed, and in the present study a series of 136 consecutive patients with PCIs of unprotected LM stenosis were analyzed. The mean Syntax Score (SS) of the study group was 26.3 ± 10.09 (11-58.5) with a median of 24.00. The mean Euro Score is 2.61 ± 4.19 (0.50-34.42) with a median of 1.22. Maximum revascularization was achieved in all subjects, and patients with STEMI and/or cardiogenic shock, previous LM PCI and protected LM PCI were excluded from the analysis. Patients were followed for 2 years for the combined indicator of adverse cardiovascular events, which included death from any cause (so-called overall mortality), cardiac mortality, stroke and revascularization. Results: 22 adverse events were registered (16.2%). The overall mortality was 9.6%, cardiac death – 8.8%, stroke – 0.7% and restenosis and revascularization – 8.1%. Conclusion: PCI of LM stenosis in patients from real clinical practice and achieving maximum revascularization is a procedure with minimal risks and favorable follow-up results, and the operator‘s experience and the capabilities of the respective medical institution to conduct such complex interventions are important.