1. Acute and Mid-Term Outcomes of Coronary Stent Implantation for the Treatment of Unprotected Left Main Coronary Artery Disease
Dr mahmoud ebrahimi
Dr hosein saghi
14/7/90
Javad-al-aemmeh Hosp

2. Background
Based on clinical trials, showing survival benefit of coronary-artery bypass grafting (CABG) over medial therapy, CABG has been regarded as the standard therapy for patients with unprotected LMCA disease.
Coronary stenting for LMCA disease suggested the favorable mid-term safety and feasibility.
Current availability of DES has reduced the rates of restenosis and revascularization, and had led to a re-evaluation of the role of PCI for LMCA disease.

4. Reason for PCI
Patients with unprotected left main disease (defined as stenosis of more than 50%)
Without suitable bypass conduits
Concurrent severe medical illness
Current malignancy
Limited life expectancy
Age ≥ 75 years and poor performance status
“good candidate for stenting”
Patient’s preference/ Patient refused surgery
Bailout UPLM stenting
Physician refused surgery
-“poor candidates for CABG”
Exclusion Criteria
Prior CABG
Concomitant valvular or aortic surgery

5. Procedures
Ostial or shaft lesions were attempted with a single stent placement. For bifurcation lesions, a single-stent technique was preferred in patients with normal-appearing side branches, and two-stent techniques were considered in patients with diseased side branches.
After the procedure, aspirin was continued indefinitely and clopidogrel or ticlopidine for at least 9-12 months.

6. Databases and Follow-up
Clinical follow-up was recommended regularly.
Angiographic follow-up was routinely recommended for all PCI patients between 6 and 10 months. However, patients without ischemic symptoms or signs, as well as patients who refused, did not undergo routine follow-up angiography.

7. Primary Outcome Measures
Death
Composite of death, Q-wave myocardial infarction, or stroke
Target-vessel revascularization

8. Results

9. Procedural Characteristics
Variable
PCI (n = 40)
Bare-metal stents(%)
Drug-eluting stents (%)
2 (5%) 38 (95%)
Number of stents at LMCA lesions 1
Total length of stents at LMCA (mm)
16.38±7.73
stent diameter at LM site
3.54±0.33
Number of stents per patients (LMCA and other vessels)
2.43±1.17

10. Baseline Characteristics
Variable
Demographic characteristics
Age (yr)
63.67±9.97
Median 65
Male sex (%)
65%
Cardiac or Coexisting conditions (%)
Diabetes mellitus
Any diabetes
16(40%)
Requiring insulin
3(7.5%)
Hypertension
21(52%)
Hyperlipidemia
Current smoker
2(5%)

11. Baseline Characteristics
Variable
Previous coronary angioplasty
10(25%)
Previous myocardial infarction
12(30%)
Chronic obstructive pulmonary disease
2(5%)
Cerebrovascular disease
Peripheral vascular disease
Renal failure
Ejection fraction (%)
45±13
Median
50%

12. Baseline Characteristics
Variable
Electrocardiographic findings
Sinus rhythm
37(70%)
Atrial fibrillation
3(7.5%)
Clinical indication (%)
Chronic stable angina
13(32.5%)
Unstable angina
16(40%)
NSTEMI
4(10%)
STEMI
5(12.5%)
Cardiogenic shock
2(%5)

13. Angiographic Characteristics
Variable
Involved location
Ostium and/or mid-shaft
9(22.5%)
Distal bifurcation
31(57%)
Extent of diseased vessel
Left main only
3(7.5%)
Left main plus single-vessel disease
13(32.5%)
Left main plus double-vessel disease
16(39.5%)
Left main plus triple-vessel disease
8(20%)
Right coronary artery disease

14. Clinical Outcomes Overall Patients (N=40) Outcome Death 2
Composite outcome
(death, Q-wave myocardial infarction, or stroke)
Target-vessel revascularization

16. zarvandi 55 yrs man Ahangar U/A FC:4 No MI EF: 57% RF; C/S,DM,HTN
SCA: sever distal LMCT disease+ sever 3VD
LAD: SEVER ostioproximal and medial& multiple lesion thereafter
LCX:ostial and distal with diffuse stenosis of Oms.
RCA: diffuse lesions & cutted at midportion

20. ALI mousavi
A 55yold man presented to ED with resting typical CP from 12 hours ago
He had exertional CP since few months ago
BP:95/ PR:90 RR: T:36.8

21. PH/E
JVP:NL
Lungs: fine crackle in the baseHeart:S1,S2:NL there was an early systolic murmur 2/6 in apex
EXT:NL

22. PMH:
HTN(+)
HLP(+)
SMOKING(+)
DM(-)
IHD:MI(?)4 years ago
DH(-)
FH(-)

23. ECG:
NSR HR:70 NL axis ST elevation and inverted T in V1-V4-Q in V1-V3 TPI(+)

24. Echocardiography:
EF:35%,akinesia in apex and hypokinesia in anterior,septal and lateral wall
Mild MR

29. “Medical treatment, PCI, and CABG should not be seen as competing strategies but rather as complementary approaches with overlapping roles. All three have their limitations and no single one will suffice. Each approach will continue to improve with time, and coronary artery disease will become a relatively benign disease.”

32. Thank You !!