Early Percutaneous Coronary Intervention for Unprotected Left Main Disease in Patient with Cardiogenic Shock: A Case-Report

The prognosis of left main coronary artery disease is largely affected by the appropriate selection of the treatment strategy. A 45-year-old male presented with severe chest pain and two episodes of ventricular tachycardia, which was reverted after DC shock. Coronary angiography revealed critical stenotic lesion in the left main coronary artery. The patient successfully underwent urgent angioplasty with stent deployment in the left main coronary artery.

Intensive care outcome of left main stem disease surgery: A single center three years’ experience

BACKGROUND Left main coronary artery(LMCA)supplies more than 80%of the left ventricle,and significant disease of this artery carries a high mortality unless intervened surgically.However,the influence of coronary artery bypass grafting(CABG)surgery on patients with LMCA disease on morbidity intensive care unit(ICU)outcomes needs to be explored.However,the impact of CABG surgery on the morbidity of the ICU population with LMCA disease is worth exploring.AIM To determine whether LMCA disease is a definitive risk factor of prolonged ICU stay as a primary outcome and early morbidity within the ICU stay as secondary outcome.METHODS Retrospective descriptive study with purposive sampling analyzing 399 patients who underwent isolated urgent or elective CABG.Patients were divided into 2 groups;those with LMCA disease as group 1(75 patients)and those without LMCA disease as group 2(324 patients).We correlated ICU outcome parameters including ICU length of stay,post-operative atrial fibrillation,acute kidney injury,re-exploration,perioperative myocardial infarction,post-operative bleeding in both groups.RESULTS Patients with LMCA disease had a significantly higher prevalence of diabetes(43.3%vs 29%,P=0.001).However,we did not find a statistically significant difference with regards to ICU stay,or other morbidity and mortality outcome measures.CONCLUSION Post-operative performance of Patients with LMCA disease who underwent CABG were comparable to those without LMCA involvement.Diabetes was more prevalent in patients with LMCA disease.These findings may help in guiding decision making for future practice and stratifying the patients’care.

Long term outcomes of drug-eluting stent versus coronary artery bypass grafting for left main coronary artery disease： a meta-analysis

Background It is still controversial whether percutaneous coronary intervention with drug-eluting stent （DES） is safe and effective compared to coronary artery bypass graft surgery （CABG） for unprotected left main coronary artery （ULMCA） disease at long-term follow up （≥3 years）. Methods Eligible studies were selected by searching PubMed, EMBASE, and Cochrane Library up to December 6, 2016. The primary endpoint was a composite of death, myocardial infarction （MI） or stroke during the longest follow-up. Death, cardiac death, MI, stroke and repeat revascularization were the secondary outcomes. Results Four randomized controlled trials and twelve adjusted observational studies involving 14,130 patients were included. DES was comparable to CABG regarding the occurrence of the primary endpoint （FIR = 0.94, 95% CI： 0.86-1.03）. Besides, DES was significantly associated with higher incidence of MI （HR = 1.56, 95% CI： 1.09-2.22） and repeat revascularization （HR = 3.09, 95% CI： 2.33-4.10） compared with CABG, while no difference was found between the two strategies regard as the rate of death, cardiac death and stroke. Furthermore, DES can reduce the risk of the composite endpoint of death, MI or stroke （HR = 0.80, 95% CI： 0.67-0.95） for ULMCA lesions with SYNTAX score ≤32. Conclusions Although with higher risk of repeat revascularization, PCI with DES appears to be as safe as CABG for ULMCA disease at long-term follow up. In addition, treatment with DES could be an alternative interventional strategy to CABG for ULMCA lesions with low to intermediate anatomic complexity.

Impact of Coronary Chronic Total Occlusion on Long-term Clinical Outcome in Patients with Unprotected Left Main Disease Undergoing Percutaneous Coronary Intervention

Objectives:Reported data regarding the prevalence,prognostic impact,and safety and efficacy of revascularization of coronary chronic total occlusion(CTO)in patients with left main coronary artery(LMCA)disease who undergo percutaneous coronary intervention(PCI)are scarce.The aim of the present study was to compare clinical outcomes among patients with LMCA disease undergoing PCI.Outcomes were compared between those with and without coronary CTO and between those with CTO who had successful and unsuccessful CTO recanalization procedures.Methods:All consecutive patients with significant LMCA disease(>50%stenosis at coronary angiography)who underwent PCI between July 2014 and December 2018 were retrospectively included in our study.The primary endpoint of the study was long-term mortality.Secondary endpoints included the incidence of myocardial infarction,repeat percutaneous or surgical revascularization,stroke,and stent thrombosis.Results:Between July 2014 and December 2018,578 patients underwent PCI for LMCA disease at Pederzoli Hospital and University of Turin were enrolled.They were divided into 3 groups:group A:374(65%)patients without CTO,group B:108(19%)patients with untreated or unsuccessfully treated CTO,and group C:96(17%)patients with successfully treated CTO.At a median follow-up of(1090±279)days,there were no statistically significant differences between the groups in terms of the primary and secondary endpoints.However,there was a trend towards higher mortality in patients with untreated or unsuccessfully treated CTO(13%vs.19%vs.14%in groups A,B,and C,respectively;P=0.12).The primary and secondary endpoints were further analyzed based on the presence or absence of myocardial viability:subgroup C1:54(56%)patients with successful percutaneous transluminal coronary angioplasty(PTCA)having viability,and subgroup C2:42(44%)patients with successful PTCA not having viability.There was a trend toward a statistically significant higher rate of death among patients in group B,who underwent unsuccessful recanalization with viable myocardium(19%vs.9%vs.19%in groups B,C1,and C2,respectively,P=0.05).On multivariable analysis,the propensity for successful revascularization of CTO was associated with a reduced risk of death(P=0.01;odds ratio,0.75;95%confidence interval:0.62-0.87).Conclusions:Among patients with LMCA disease undergoing PCI,CTO represents a common finding associated with worse prognosis.Successful revascularization of CTO in patients with viable myocardium appears to significantly improve prognosis.

Transcatheter aortic valve replacement(TAVR) for severe aortic valve stenosis with left main artery disease:A case report

Introduction: This is the first case of Transcatheter Aortic Valve Replacement(TAVR) in the prefecture level hospital of Xinjiang Province in China. It also proves that severe left main coronary artery disease(LM)is not the contraindication to this operation of TAVR. Patient concerns:The patient had dyspnea for two years, with the 4/6 spurious murmur at the aortic valve. The cardiac ultrasound revealed a severe aortic valve stenosis(AS) and severe mitral regurgitation(MR). Coronary angiography(CAG)showed 80% stenosis of the left main artery. Diagnosis: The severe aortic valve stenosis(AS). Interventions: He received the TAVR, which also is the first case in the First People's Hospital of Kashi Prefecture. Outcomes: The patient's symptoms were significantly improved. The cardiac ultrasound showed that no obvious regurgitation was found in the implanted artificial aortic valve and the MR was significantly reduced. So far, the patient has recovered well for five months after TAVR. Conclusion:TAVR is an effective method for the severe AS patients with serve LM and loss of surgical opportunity.

Long-term clinical outcomes of patients with unprotected left main bifurcation lesions treated with 2-stent techniques

Background Currently available evidence suggests that outcomes are less favorable when left main （LM） bifurcation lesions are treated with 2-stent techniques compared with a single-stent technique. We aimed to evaluate the long-term outcomes of the 2-stent techniques for treating unprotected LM bifurcation lesions in Chinese patients. Methods We enrolled 301 consecutive patients treated with drug-eluting stents （DES） implantation using 2-stent techniques for unprotected LM bifurcation lesions （MEDINA 1, 1, 1, 70.5%）. The 2-stent techniques included crush technique, V stenting, T stenting, and Culottes stenting. After stenting, both vessels were redilated at a high pressure before final kissing balloon （FKB）. Clinical and angiographic data were analyzed. The primary endpoints were major adverse cardiac events （MACE）, which included death, myocardial infarction, and target lesion revascularization. Results Immediate procedural success was obtained in all cases with a FKB success rate of 95.3%. Follow-up data were available for all patients. The overall incidence of angiographic in-stent restenosis （ISR） rate was 20.3% and most ISRs were of the focal type. During long-term follow-up （mean duration, （54＋22） months）, the cumulative incidence of MACE was 11.0%, with 8 （2.7%） deaths, 7 （2.3%） myocardial infarctions, and 18 （6.0%） repeated lesion revascularization. MACEs in high SYNTAX score terciles were significantly higher compared with those in low and intermediate SYNTAX score terciles （P=0.001）. Conclusions Although percutaneous coronary intervention （PCI） with 2-stent technique for unprotected LM bifurcation lesions was accompanied with a slightly high incidence of ISR, the long-term clinical follow-up is acceptable. Technical modifications and stent innovations may further improve both the angiographic and clinical outcomes for patients with LM bifurcation disease treated by PCI.

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Contrast-induced acute kidney injury after primary percutaneous coronary intervention： Results from theHORIZONS-AMI substudy