Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients

Walter A. Tan, Hideo Tamai, Seung Jung Park, H. W Thijs Plokker, Masakiyo Nobuyoshi, Takahiko Suzuki, Antonio Colombo, Carlos Macaya, David R. Holmes, David J. Cohen, Patrick L. Whitlow, Stephen G. Ellis

Research output: Contribution to journalArticle

244 Citations (Scopus)

Abstract

Background - Percutaneous coronary revascularization (PCI) has been increasingly applied to unprotected left main trunk (LMT) lesions, with varied long-term success. This study attempts to define the predictors of outcome in this population. Methods and Results - Two hundred seventy-nine consecutive patients who had LMT PCI at 1 of 25 sites between 1993 and 1998 were studied. Forty-six percent of these patients were deemed inoperable or at high surgical risk. Thirty-eight patients (13.7%) died in hospital, and the rest were followed up for a mean of 19 months. The 1-year incidence was 24.2% for all-cause mortality, 20.2% for cardiac mortality, 9.8% for myocardial infarction, and 9.4% for CABG. Independent correlates of all-cause mortality were left ventricular ejection fraction ≤30%, mitral regurgitation grade 3 or 4, presentation with myocardial infarction and shock, creatinine ≥2.0 mg/dL, and severe lesion calcification. For the 32% of patients 30% and without shock, the prevalence of these adverse risk factors was low. No periprocedural deaths were observed in this low-risk subset, and the 1-year mortality was only 3.4%. Conclusions - Patients undergoing unprotected LMT PCI have frequent serious comorbidities and consequently have high event rates. PCI may be an alternative to CABG for a select proportion of elective patients and may also be appropriate for highly symptomatic inoperable patients. Meticulous follow-up of hospital survivors is required because of the rather high mortality during the first few months after treatment.

Original languageEnglish
Pages (from-to)1609-1614
Number of pages6
JournalCirculation
Volume104
Issue number14
Publication statusPublished - Oct 2 2001

Fingerprint

Percutaneous Coronary Intervention
Mortality
Shock
Myocardial Infarction
Mitral Valve Insufficiency
Stroke Volume
Survivors
Comorbidity
Creatinine
Incidence
Population
Therapeutics

Keywords

  • Angioplasty
  • Coronary disease
  • Revascularization
  • Stents

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Tan, W. A., Tamai, H., Park, S. J., Plokker, H. W. T., Nobuyoshi, M., Suzuki, T., ... Ellis, S. G. (2001). Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients. Circulation, 104(14), 1609-1614.

Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients. / Tan, Walter A.; Tamai, Hideo; Park, Seung Jung; Plokker, H. W Thijs; Nobuyoshi, Masakiyo; Suzuki, Takahiko; Colombo, Antonio; Macaya, Carlos; Holmes, David R.; Cohen, David J.; Whitlow, Patrick L.; Ellis, Stephen G.

In: Circulation, Vol. 104, No. 14, 02.10.2001, p. 1609-1614.

Research output: Contribution to journalArticle

Tan, WA, Tamai, H, Park, SJ, Plokker, HWT, Nobuyoshi, M, Suzuki, T, Colombo, A, Macaya, C, Holmes, DR, Cohen, DJ, Whitlow, PL & Ellis, SG 2001, 'Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients', Circulation, vol. 104, no. 14, pp. 1609-1614.
Tan WA, Tamai H, Park SJ, Plokker HWT, Nobuyoshi M, Suzuki T et al. Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients. Circulation. 2001 Oct 2;104(14):1609-1614.
Tan, Walter A. ; Tamai, Hideo ; Park, Seung Jung ; Plokker, H. W Thijs ; Nobuyoshi, Masakiyo ; Suzuki, Takahiko ; Colombo, Antonio ; Macaya, Carlos ; Holmes, David R. ; Cohen, David J. ; Whitlow, Patrick L. ; Ellis, Stephen G. / Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients. In: Circulation. 2001 ; Vol. 104, No. 14. pp. 1609-1614.
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abstract = "Background - Percutaneous coronary revascularization (PCI) has been increasingly applied to unprotected left main trunk (LMT) lesions, with varied long-term success. This study attempts to define the predictors of outcome in this population. Methods and Results - Two hundred seventy-nine consecutive patients who had LMT PCI at 1 of 25 sites between 1993 and 1998 were studied. Forty-six percent of these patients were deemed inoperable or at high surgical risk. Thirty-eight patients (13.7{\%}) died in hospital, and the rest were followed up for a mean of 19 months. The 1-year incidence was 24.2{\%} for all-cause mortality, 20.2{\%} for cardiac mortality, 9.8{\%} for myocardial infarction, and 9.4{\%} for CABG. Independent correlates of all-cause mortality were left ventricular ejection fraction ≤30{\%}, mitral regurgitation grade 3 or 4, presentation with myocardial infarction and shock, creatinine ≥2.0 mg/dL, and severe lesion calcification. For the 32{\%} of patients 30{\%} and without shock, the prevalence of these adverse risk factors was low. No periprocedural deaths were observed in this low-risk subset, and the 1-year mortality was only 3.4{\%}. Conclusions - Patients undergoing unprotected LMT PCI have frequent serious comorbidities and consequently have high event rates. PCI may be an alternative to CABG for a select proportion of elective patients and may also be appropriate for highly symptomatic inoperable patients. Meticulous follow-up of hospital survivors is required because of the rather high mortality during the first few months after treatment.",
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AU - Tamai, Hideo

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AU - Nobuyoshi, Masakiyo

AU - Suzuki, Takahiko

AU - Colombo, Antonio

AU - Macaya, Carlos

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AU - Ellis, Stephen G.

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