ABSTRACT
Introduction@#Left main coronary artery (LMCA) is a large vessel which supplies the majority of left ventricle and critical lesion at the bifurcation of LMCA can lead to life threatening condition. Therefore, percutaneous coronary intervention (PCI) on LMCA bifurcational stenosis is considered as a complex high risk indicated patient and procedure (CHIP).@*Goal@#In this study, we investigated the impact of urgent and elective PCI on outcomes of patients with LMCA bifurcational stenosis. @*Materials and Methods@#Patients who underwent for urgent PCI due to acute myocardial infarction (AMI) or elective PCI due to stable coronary artery disease (CAD) for their LMCA bifurcational stenosis. Any lesion with >50% stenosis on coronary angiography was considered as a critical stenosis. LMCA bifurcational stenosis was evaluated by Medina classification. Difference between urgent and elective PCI group were compared by independent sample t-test and chi-square test. Association between treatment strategy (urgent or elective PCI) and prognosis were evaluated by Cox proportional hazard regression, and survival rate was evaluated by Kaplan-Meier methods. Ethical approval was taken from the ethical committee of the Health Science University of Medical Sciences (№30/1А) in June 12, 2012. @*Results@#A total of 82 patients with LMCA bifurcational stenosis were included (mean age 62±11, male 76.8%) and 14 of them underwent urgent PCI due to AMI and 68 of had elective PCI due to stable CAD. Patients who underwent urgent PCI had significantly higher 30-day mortality (1.5% vs. 21.4%, p<0.05) and all-cause mortality (7.4% vs. 35.7%, p<0.003) compared to the elective PCI group. Urgent PCI for LMCA bifurcational stenosis due to AMI was associated with increased risk of death (HR=3.63, 95% CI 1.02-12.9, p<0.05). Kaplan-Meier estimation showed that patients in the urgent PCI group had significantly lower survival compared to the elective PCI group.@*Conclusion@#Unanticipated urgent PCI for patients with LMCA bifurcational stenosis due to AMI is associated with higher risk of short and long-term mortality. Patients who underwent urgent PCI for LMCA bifurcational stenosis had significantly lower survival compared to elective PCI group.
ABSTRACT
Introduction @#The left main (LM) bifurcational stenting is coronary high risk interventional procedure (CHIP) which associated with various post procedural outcome.@*Goal@#In this study, we aimed to describe current practice of coronary left main bifurcational stenting and patient’s outcome in Mongolia. @*Materials and Methods@#We selected 50 patients who gave informed consent and treated by left main bifurcational stent. All the patients gave informed consent form which was approved by ethical committee of Mongolian National University of Medical Sciences. Coronary stenosis was evaluated by Syntax score and Medina classification. The 1 year survival rate was estimated using Kaplan-Meier estimation. @*Results @#A total of 50 patients who received LM bifurcational stent were chosen (mean age 60±11, male gender 78%). Mean syntax I score was 26.1±8.6 and mean Syntax II score was 44.7±6.2. Medina 110 type lesion was 46% (n=23), medina 111 type lesion was 36% (n=18), medina 100 type lesion was 6% (n=3), medina 011 type lesion was 4% (n=2) and medina 010 type lesion was 8% (n=4). The median degree of stenosis was 50% (IQR 30%; 90%) for LM, 90% (IQR 80%; 99%) for LAD and 0% (IQR 0%; 80%) for LCx. The final procedural success with final TIMI 3 flow was achieved in 44 patients (88%). All-cause mortality was occurred 5 patients during follow-up and survival rate at the 1 year was 82% (95% CI 66; 97).@*Conclusion @#The bifurcational stenting is acceptable treatment choice which has good survival for high risk patients with LM bifurcational disease.