Abstract

DIAZ PICADO, Geiner  and  CHAVARRIA VIQUEZ, Jorge. Revascularización Percutánea de Emergencia del Tronco Común de la Arteria Coronaria Izquierda: Resultados tempranos y seguimiento. Rev. costarric. cardiol [online]. 2010, vol.12, n.1-2, pp.05-10. ISSN 1409-4142.

Emergency Stenting of "unprotected" left main coronary artery stenoses. Primary results and follow-up. Introduction. Coronary-artery bypass grafting (CABG) has been the treatment of choice to treat complex coronary artery disease or left main coronary artery stenoses, although percutaneous coronary intervention involving stents is increasingly used to treat these forms of coronary disease in experienced centers. Objective. To evaluate results of emergency angioplasty with stenting of unprotected left main coronary artery stenoses in acute coronary syndromes associated with high risk or cardiogenic shock. Material and methods. Twelve percutaneous coronary interventions were performed on left main coronary artery obstructions; 6 patients were enrolled during acute myocardial infarction, 4 with high risk unstable angina and 2 because of left main coronary artery dissection during percutaneous interventions on other coronary arteries. In 4 patients, the intervention was performed during cardiogenic shock. Hospital mortality was recorded and compared with the expected rate, according to the EUROSCORE index. Results. The median age was 75 years and all procedures were performed as emergencies.  Of the patients, 25% were women, 83% had hypertension, 33% were active smokers, 50% were patients with a history of prior CABG, and 41% had had a recent myocardial infarction.  Angiographic success was 100%, but one patient died despite a successful coronary artery dilatation. All were treated with deployment of a stent. The average follow-up period was 8.4 months.  There was 1 in-hospital death, 1 death occurred at the end of the first month of follow-up and 2 deaths occurred after a year from the initial procedure. There was no occurrence of a non-fatal myocardial infarction in the unstable angina group treated with percutaneous coronary intervention. The median EUROSCORE index was 11 points, as expected for this population. Conclusion. Rescue left main coronary artery angioplasty with stenting in the context of an acute coronary syndrome, is effective and carries a low mortality. Nevertheless, further investigation is necessary to evaluate the role of this approach as compared to CABG.

Keywords : Percutaneous coronary intervention; Surgical revascularization; Left main corornary artery; acute coronary syndrome.

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