Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 3, Number 3, June 2012, pages 100-108

Real World Application of Stenting of Unprotected Left Main Coronary Stenosis: A Single-Center Experience

Figure 1. Kaplan-Meier graph of outcomes for left main percutaneous coronary intervention. Kaplan-Meier outcomes curves for individual and composite outcomes: death, target vessel revascularization (TVR), and myocardial infarction (MI) for patients undergoing left main coronary artery intervention.

Figure 2. Risk adjusted Kaplan-Meier graph of survival for left main percutaneous coronary intervention by bifurcation or nonbifurcation. Risk adjusted Kaplan-Meier survival curve by for bifurcation and nonbifurcation with log-rank analysis adjusted for age, CHF, EF ≤ 35, cardiogenic shock, and creatinine > 2.

Figure 3. Kaplan-Meier graph of survival for left main percutaneous coronary intervention by priority. Kaplan-Meier survival curve by priority designation: elective, urgent, and emergent with log-rank analysis.

**Table 1.** Characteristics for All Patients and Comparison of Bifurcation and Non-Bifurcation Cohorts
Variables	All	Bifurcation	Non-bifurcation	P-value
Number (N = 125)	125 (100%)	64 (51.2%)	61 (48.8%)
Demographics
Age (years)	73.7 ± 10.9	73.9 ± 11.0	73.5 ± 10.9	0.85
Gender (female; %)	40.8	39.1	42.6	0.69
Body mass index	28.2 ± 6.7	28.3 ± 6.6	28.0 ± 6.9	0.79
Co-morbidities
Chronic obstructive pulmonary disease (%)	20.0	18.8	21.3	0.72
Peripheral vascular disease (%)	34.4	37.5	31.2	0.46
Baseline creatinine (mg/dL)	1.4 ± 1.1	1.3 ± 0.8	1.5 ± 1.4	0.26
Creatinine >2 mg/dL (%)	10.4	7.8	13.1	0.33
Risk Factors
Diabetes (%)	36.8	31.3	42.6	0.19
Smoking history (%)	52.0	48.4	55.7	0.41
Hypertension (%)	79.2	81.3	77.0	0.56
Hypercholesterolemia (%)	72.8	71.9	73.8	0.81
Family history of CAD (%)	36.0	39.1	32.8	0.47
Previous Cardiac History and Cardiac Function
History of CAD (%)	58.4	62.5	54.1	0.34
Prior thrombolysis (%)	3.2	1.6	4.9	0.29
Prior PCI (%)	21.6	28.1	14.8	0.07
Prior CABG (%)	0.8	0.0	1.6	0.30
EF	49.3 ± 15.2	52.2 ± 13.8	46.1 ± 16.0	0.02
EF ≤ 35% (%)	23.2	15.6	31.1	0.04
Mitral regurgitation ≥ 2+ (%)	26.4	18.8	24.6	0.43
Indications for intervention
Stable angina (%)	16.0	17.2	14.8	0.71
ST-elevation MI (%)	10.4	10.9	9.8	0.84
Non-ST-elevation MI (%)	60.0	60.9	59.0	0.83
Unstable angina (%)	8.8	7.8	9.8	0.69
Cardiogenic shock (%)	18.4	17.2	19.7	0.72
Non-surgical candidate (%)	50.4	53.1	47.5	0.53
Parsonnet score	22.1 ± 22.6	22.1 ± 21.9	22.2 ± 23.6	0.98
Euroscore (Logistic)	17.0 ± 16.6	15.7 ± 15.8	18.3 ± 17.5	0.39
Euroscore (Additive)	8.5 ± 3.9	8.3 ± 3.7	8.7 ± 4.2	0.54
Northern New England In-hospital Predicted Mortality Probabilities for PCI	13.3 ± 21.8	10.8 ± 18.3	16.0 ± 24.8	0.18
Northern New England In-hospital Predicted Mortality Probabilities for CABG	8.6 ± 9.2	8.0 ± 9.1	9.3 ± 9.3	0.4
Priority Indication
Elective (%)	12.8	9.4	16.4	0.41
Urgent (%)	64.0	68.8	59.0
Emergent (%)	23.2	21.9	24.6

Table 1. Characteristics for All Patients and Comparison of Bifurcation and Non-Bifurcation Cohorts

Variables

All

Bifurcation

Non-bifurcation

P-value

Number (N = 125)

125 (100%)

64 (51.2%)

61 (48.8%)

Demographics

Age (years)

73.7 ± 10.9

73.9 ± 11.0

73.5 ± 10.9

0.85

Gender (female; %)

40.8

39.1

42.6

0.69

Body mass index

28.2 ± 6.7

28.3 ± 6.6

28.0 ± 6.9

0.79

Co-morbidities

Chronic obstructive pulmonary disease (%)

20.0

18.8

21.3

0.72

Peripheral vascular disease (%)

34.4

37.5

31.2

0.46

Baseline creatinine (mg/dL)

1.4 ± 1.1

1.3 ± 0.8

1.5 ± 1.4

0.26

Creatinine >2 mg/dL (%)

10.4

7.8

13.1

0.33

Risk Factors

Diabetes (%)

36.8

31.3

42.6

0.19

Smoking history (%)

52.0

48.4

55.7

0.41

Hypertension (%)

79.2

81.3

77.0

0.56

Hypercholesterolemia (%)

72.8

71.9

73.8

0.81

Family history of CAD (%)

36.0

39.1

32.8

0.47

Previous Cardiac History and Cardiac Function

History of CAD (%)

58.4

62.5

54.1

0.34

Prior thrombolysis (%)

3.2

1.6

4.9

0.29

Prior PCI (%)

21.6

28.1

14.8

0.07

Prior CABG (%)

0.8

0.0

1.6

0.30

49.3 ± 15.2

52.2 ± 13.8

46.1 ± 16.0

0.02

EF ≤ 35% (%)

23.2

15.6

31.1

0.04

Mitral regurgitation ≥ 2+ (%)

26.4

18.8

24.6

0.43

Indications for intervention

Stable angina (%)

16.0

17.2

14.8

0.71

ST-elevation MI (%)

10.4

10.9

9.8

0.84

Non-ST-elevation MI (%)

60.0

60.9

59.0

0.83

Unstable angina (%)

8.8

7.8

9.8

0.69

Cardiogenic shock (%)

18.4

17.2

19.7

0.72

Non-surgical candidate (%)

50.4

53.1

47.5

0.53

Parsonnet score

22.1 ± 22.6

22.1 ± 21.9

22.2 ± 23.6

0.98

Euroscore (Logistic)

17.0 ± 16.6

15.7 ± 15.8

18.3 ± 17.5

0.39

Euroscore (Additive)

8.5 ± 3.9

8.3 ± 3.7

8.7 ± 4.2

0.54

Northern New England In-hospital Predicted Mortality Probabilities for PCI

13.3 ± 21.8

10.8 ± 18.3

16.0 ± 24.8

0.18

Northern New England In-hospital Predicted Mortality Probabilities for CABG

8.6 ± 9.2

8.0 ± 9.1

9.3 ± 9.3

0.4

Priority Indication

Elective (%)

12.8

9.4

16.4

0.41

Urgent (%)

64.0

68.8

59.0

Emergent (%)

23.2

21.9

24.6

**Table 2.** Procedural Data for all Patients and Comparison of Bifurcation and Non-Bifurcation Cohorts
Variables	All	Bifurcation	Non-bifurcation	P-value
Number (N = 125)	125 (100%)	64 (51.2%)	61 (48.8%)
IVUS use (%)	72.8	70.3	75.4	0.52
IABP use (%)	45.6	50.0	41.0	0.31
# of diseased vessels	2.4 ± 0.9	2.6 ± 0.7	2.2 ± 1.0	0.01
3 vessel disease (%)	63.2	73.4	52.5	0.02
Total stent count	3.0 ± 2.0	3.6 ± 2.0	2.3 ± 1.8	< 0.001
Left main stent count	1.7 ± 0.8	2.3 ± 0.7	1.1 ± 0.3	< 0.001
Heparin use (%)	78.4	84.4	72.1	0.10
IIb/IIIa inhibitor use (%)	26.4	35.9	16.4	0.01
Bivalirudin use (%)	41.6	32.8	50.8	0.04
Bifurcation stenting technique
Angioplasty rescue (%)	30.2
Crush stent (%)	15.9
Culotte stent (%)	20.6
Double barrel stent (%)	6.3
Single stent (%)	3.2
T stent (%)	20.6
V stent (%)	1.6
Y stent (%)	1.6

Table 2. Procedural Data for all Patients and Comparison of Bifurcation and Non-Bifurcation Cohorts

Variables

All

Bifurcation

Non-bifurcation

P-value

Number (N = 125)

125 (100%)

64 (51.2%)

61 (48.8%)

IVUS use (%)

72.8

70.3

75.4

0.52

IABP use (%)

45.6

50.0

41.0

0.31

# of diseased vessels

2.4 ± 0.9

2.6 ± 0.7

2.2 ± 1.0

0.01

3 vessel disease (%)

63.2

73.4

52.5

0.02

Total stent count

3.0 ± 2.0

3.6 ± 2.0

2.3 ± 1.8

< 0.001

Left main stent count

1.7 ± 0.8

2.3 ± 0.7

1.1 ± 0.3

< 0.001

Heparin use (%)

78.4

84.4

72.1

0.10

IIb/IIIa inhibitor use (%)

26.4

35.9

16.4

0.01

Bivalirudin use (%)

41.6

32.8

50.8

0.04

Bifurcation stenting technique

Angioplasty rescue (%)

30.2

Crush stent (%)

15.9

Culotte stent (%)

20.6

Double barrel stent (%)

6.3

Single stent (%)

3.2

T stent (%)

20.6

V stent (%)

1.6

Y stent (%)

1.6

**Table 3.** Outcomes for all Patients and Comparison of Bifurcation and Non-Bifurcation Cohorts
Variables	All	Bifurcation	Non-bifurcation	P-value
Number (N = 125)	125 (100%)	64 (51.2%)	61 (48.8%)
Mean follow-up (years)	1.8 ± 1.2	1.6 ± 1.2	1.9 ± 1.3	0.07
Mortality (%)	28.8	37.5	19.7	0.03
In-hospital mortality	8.8	12.5	4.9	0.14
Any revascularization (%)	21.6	26.6	16.4	0.17
TVR (%)	13.6	14.1	13.1	0.88
MI (%)	7.2	7.8	6.6	0.79
Mean time to death (years)	0.6 ± 0.8	0.6 ± 0.9	0.5 ± 0.8	0.62
Mean time to TVR (years)	0.6 ± 0.4	0.4 ± 0.2	0.8 ± 0.5	0.03
Mean time to any revascularization (years)	0.5 ± 0.4	0.4 ± 0.3	0.6 ± 0.6	0.19

Table 3. Outcomes for all Patients and Comparison of Bifurcation and Non-Bifurcation Cohorts

Variables

All

Bifurcation

Non-bifurcation

P-value

Number (N = 125)

125 (100%)

64 (51.2%)

61 (48.8%)

Mean follow-up (years)

1.8 ± 1.2

1.6 ± 1.2

1.9 ± 1.3

0.07

Mortality (%)

28.8

37.5

19.7

0.03

In-hospital mortality

8.8

12.5

4.9

0.14

Any revascularization (%)

21.6

26.6

16.4

0.17

TVR (%)

13.6

14.1

13.1

0.88

MI (%)

7.2

7.8

6.6

0.79

Mean time to death (years)

0.6 ± 0.8

0.6 ± 0.9

0.5 ± 0.8

0.62

Mean time to TVR (years)

0.6 ± 0.4

0.4 ± 0.2

0.8 ± 0.5

0.03

Mean time to any revascularization (years)

0.5 ± 0.4

0.4 ± 0.3

0.6 ± 0.6

0.19

**Table 4.** Crude and Adjusted Hazard Ratios
Risk Factor	Crude HR	95%CI	Adjusted HR	95% CI
EF < 35	2.33	(1.18 - 4.60)	2.44	(1.10 - 5.42)
LM bifurcation	2.07	(1.03 - 4.14)	2.65	(1.24 - 5.67)
IABP	3.73	(1.80 - 7.74)	1.67	(0.67 - 4.13)
Parsonnet Score	1.03	(1.02 - 1.04)	1.03	(1.00 - 1.05)
Euroscore	1.04	(1.02 - 1.06)	1.00	(0.97 - 1.03)
Cardiogenic Shock	3.00	(1.47 - 6.12)	0.64	(0.18 - 2.28)
Positive Troponin	3.27	(1.27 - 8.41)	1.90	(0.69 - 5.26)
Emergent	2.54	(1.29 - 5.02)	1.11	(0.39 - 3.17)

Table 4. Crude and Adjusted Hazard Ratios

Risk Factor

Crude HR

95%CI

Adjusted HR

95% CI

EF < 35

2.33

(1.18 - 4.60)

2.44

(1.10 - 5.42)

LM bifurcation

2.07

(1.03 - 4.14)

2.65

(1.24 - 5.67)

IABP

3.73

(1.80 - 7.74)

1.67

(0.67 - 4.13)

Parsonnet Score

1.03

(1.02 - 1.04)

1.03

(1.00 - 1.05)

Euroscore

1.04

(1.02 - 1.06)

1.00

(0.97 - 1.03)

Cardiogenic Shock

3.00

(1.47 - 6.12)

0.64

(0.18 - 2.28)

Positive Troponin

3.27

(1.27 - 8.41)

1.90

(0.69 - 5.26)

Emergent

2.54

(1.29 - 5.02)

1.11

(0.39 - 3.17)