Long Term Outcome of Percutaneous Coronary Intervention in Patients with Unprotected Left Main Disease

Main Article Content

Nasir Farooq
Muhammad Osama
Atta Ul Wadood

Abstract

Background: The management of unprotected left main coronary artery disease (LM CAD) poses a significant clinical challenge. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) have been extensively compared, with PCI emerging as a viable option for specific patient subsets. Advancements in interventional cardiology, including drug-eluting stents and intravascular ultrasound, have improved PCI outcomes, yet long-term efficacy remains a subject of investigation.


Objective: This study aims to evaluate the long-term outcomes of PCI in patients with unprotected LM CAD, focusing on all-cause mortality, cardiac deaths, myocardial infarction, revascularization, and stroke.


Methods: A descriptive cross-sectional study was conducted at the Peshawar Institute of Cardiology, KPK, from November 2022 to October 2023. A total of 120 patients aged 55-70 years with LM disease undergoing PCI were included. Long-term outcomes were assessed after five years. Data analysis was performed using SPSS version 23, focusing on frequency and association of outcomes with gender.


Results: The study observed all-cause mortality in 15.0% (n=18) of the patients, cardiovascular mortality in 6.7% (n=8), myocardial infarction in 7.5% (n=9), revascularization in 14.2% (n=17), and stroke in 4.2% (n=5). Gender analysis revealed no significant difference in all-cause mortality (P=0.73), with a notable gender disparity in cardiovascular mortality favoring females (P=0.04). Revascularization and stroke rates did not significantly differ by gender.


Conclusion: PCI presents a favorable and safe long-term treatment option for patients with unprotected LM CAD, with significant outcomes in terms of mortality, myocardial infarction, revascularization, and stroke. The study supports the continued use of PCI in clinical practice, highlighting the necessity for further comparative research with CABG to optimize patient outcomes.

Article Details

How to Cite
Farooq, N., Osama, M., & Wadood, A. U. (2024). Long Term Outcome of Percutaneous Coronary Intervention in Patients with Unprotected Left Main Disease. Journal of Health and Rehabilitation Research, 4(1), 366–370. https://doi.org/10.61919/jhrr.v4i1.419
Section
Articles
Author Biographies

Nasir Farooq, Peshawar Institute of Cardiology KPK Pakistan.

Registrar.

Muhammad Osama, Peshawar Institute of Cardiology KPK Pakistan.

TMO.

Atta Ul Wadood, Peshawar Institute of Cardiology KPK Pakistan.

TMO.

References

Shao C, Wang J, Tian J, Tang YD. Coronary artery disease: from mechanism to clinical practice. Coronary Artery Disease: Drug Discov Ther. 2020:12(5):17-25.

Khan AR, Golwala H, Tripathi A, Riaz H, Kumar A. Meta-analysis of percutaneous coronary intervention versus coronary artery bypass grafting in left main coronary artery disease. Am J Card. 2017;119(12):1949-56.

Stone GW, Kappetein AP, Sabik JF, Pocock SJ, Morice MC, Puskas J, et al. Five-year outcomes after PCI or CABG for left main coronary disease. N Engl J Med. 2019;381(19):1820-30.

Kwok CS, Gale CP, Curzen N, De Belder MA, Ludman P, Lüscher TF, et al. Impact of the COVID-19 pandemic on percutaneous coronary intervention in England: insights from the British Cardiovascular Intervention Society PCI database cohort. Circ Cardiovasc Interv. 2020;13(11):e009654.

Doenst T, Haverich A, Serruys P, Bonow RO, Kappetein P, Falk V, et al. PCI and CABG for treating stable coronary artery disease: JACC review topic of the week. J Am Coll Cardiol. 2019;73(8):964-76.

Fajadet J, Capodanno D, Stone GW. Management of left main disease: an update. Eur Heart J. 2019;40(18):1454-66.

Hyun J, Kim JH, Jeong Y, Choe K, Lee J, Yang Y, et al. Long-term outcomes after PCI or CABG for left main coronary artery disease according to lesion location. Cardiovascular Interventions. 2020 ;13(24):2825-36.

Kosmidou I, Chen S, Kappetein AP, Serruys PW, Gersh BJ, Puskas JD, et al. New-onset atrial fibrillation after PCI or CABG for left main disease: the EXCEL trial. J Am Coll Cardiol. 2018;71(7):739-48.

Stone PH, Goldschlager N. Left main coronary-artery diseasereview and appraisal. Cardiovasc Med. 1979;4:165.

Kalbfleisch H, Hort W. Quantitative study on the size of coronary artery supplying areas postmortem. Am Heart J. 1977;94(25):183-8.

Mäkikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet. 2016;388(10061):2743-52.

Holm NR, Mäkikallio T, Lindsay MM, Spence MS, Erglis A, Menown IB, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet. 2020;395(10219):191-9.

Neumann F.J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning A.P, Benedetto U, et al, ESC Scientific Document Group; et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. Heart J. 2019, 40, 87–165.

Thuijs D.J.F.M, Kappetein A.P, Serruys P.W, Mohr F.-W, Morice MJ, et al. SYNTAX Extended Survival Investigators; et al. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet 2019, 394, 1325–1334.

Stone, G.W, Kappetein, A.P, Sabik, J.F, Pocock, S.J, Morice, Steve M.C, et al, Brown, W.M., II; EXCEL Trial Investigators; et al. Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease. N. Engl. J. Med. 2019, 381, 1820–1830.

Dores H, Raposo L, Almeida MS, Brito J, Santos PG, Sousa PJ, et al. Percutaneous coronary intervention of unprotected left main disease: five-year outcome of a single-center registry. Rev Port Cardiol. 2013;32(12):997-1004.

Gao L, Gao Z, Song Y, Guan C, Xu B, Chen J, et al. Long-Term Clinical Outcomes of Unprotected Left Main Percutaneous Coronary Intervention: A Large Single-Centre Experience. J Interv Cardiol. 2021 Jan 12;2021:8829686.

Bajraktari G, Zhubi-Bakija F, Ndrepepa G, Alfonso F, Elezi S, Rexhaj Z, et al. Long-Term Outcomes of Patients with Unprotected Left Main Coronary Artery Disease Treated with Percutaneous Angioplasty versus Bypass Grafting: A Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2020;9(7):2231.

Moț ȘD, Șerban AM, Achim A, Dădârlat-Pop A, Tomoaia R, Pop D. Clinical Characteristics and Outcomes following Percutaneous Coronary Intervention in Unprotected Left Main Disease: A Single-Center Study. Diagnostics. 2023 Apr 3;13(7):1333.

Kim TO, Kang DY, Ahn JM, Kim MJ, Lee PH, Kim H, Choi Y, Lee J, Lee JM, Jo HH, Park YS. Impact of Target Lesion Revascularization on Long-Term Mortality After Percutaneous Coronary Intervention for Left Main Disease. Cardiovascular Interventions. 2024 Jan 8;17(1):32-42.

Most read articles by the same author(s)