We already reported the results of 51 unprotected left main coronary artery (LMCA) angioplasties in the acute clinical setting compared with a clinical-matched cohort of 37 patients referred to CABG.
Regarding the LMCA angioplasty cohort, the 6 months and one year follow-up showed a major adverse cardiovascular and cerebrovascular event (MACCE) free survival of 90% and 88% respectively. This fact, is equivalent to a MACCE rate of 6%. The surgical cohort showed a MACCE rate of 15%, mainly driven by cerebrovascular events.
The aim of this report is to further investigate the outcomes, 6 years after the index procedure in the angioplasty subgroup.
This long-term follow-up data, is available for 90% of patients, revealing actuarial 6-years survival rates of 70%, 36 patients are alive. The target lesion revascularization (TLR) rate was 50%, mainly in cases of distal bifurcation disease. The majority of the TLR cases underwent elective CABG.
We conclude, that LMCA angioplasty in the setting of acute coronary syndromes, can be effective as a salvage procedure, however, adjunctive CABG surgery is important to long term survival especially with lesions located at the distal segment. Currently, with further operators’ experience and new procedural and imaging technologies, alongside with better understanding of the anatomical and functional issues, is mandatory to extend the research to a lower risk population. Hopefully, the EXCELL trial will further elucidate this critical issue.
