LEFT MAIN STENTING
- Stenting of narrowed or blocked coronary arteries is a common and relatively easy procedure
- However, stenting of the Left Main requires more experience and expertise as mishaps may result in unacceptable complication or death
- I have been doing Left Main stenting since 2007
- We have been collecting these cases and follow up with their progress
- In more recent years, my colleagues in Changi General Hospital also contributed cases into our follow up series
- In January of 2016, we have the privilege of presenting our results in the Asia PCR/SingLive conference
- This is one of largest series and longest follow up coming out of Singapore with a maximum follow up of 7 years
- I am pleased to say that our results are comparable to those of international standard
- The following slides were presented by Dr. Mathew Liew at the meeting with minor edits
Outcome of unprotected left main coronary artery percutaneous coronary intervention: Single centre longitudinal follow up study
Background
- There has been increasing data regarding PCI of the unprotected left main coronary artery (ULMCA) and their outcomes. However there is a lack of data on the longer term outcomes in our local population following such intervention.
- Aim: To evaluate the long term outcomes of patients who underwent unprotected left main PCI in our local population
Method
- A retrospective analysis of all ULMCA PCI cases that were performed from 2007 to 2013
- on an urgent basis
- had refused surgical revascularization
- Baseline demographics and follow up outcomes were collected
- Mean follow up period was 3 years (range = 3 to 7 years)
- Multivariate analysis was performed using the statistic program SPSS version 19 to identify potential predictors of adverse outcomes


Elective vs unplanned LM PCI
- In the elective PCI group:
- More frequent femoral use (93.3% vs 56.5%)
- No IABP inserted
- Fewer patients with EF <40% (20.5% vs 56.5%)
- Fewer patients with Medina (1,1,1) anatomy (11.1% vs 30.4%)
- Fewer patients with Euroscore >5 (40% vs 82.6%)

Results
- Overall MACE rates: 11.8% (8 out of 68 cases)
- Death: 10.3%
- Target lesion revascularisation: 1.5%
- Elective PCI: 6.6%
- 2 deaths (4.4%) out of 45 patients
- Of which one was sepsis, and one was sudden death
- 1 target lesion revascularisation (2.2%)

Results
Non-elective PCI: 42.5%
- 5 deaths
- Acute LM occlusion cases (5 out of 11, 42.5%)
- Presented with cardiogenic shock
Results
- Use of IABP (P = 0.05) (patients in cardiogenic shock) and low ejection fraction (<40%) (p = 0.04) were independent predictors of MACE at 3years.
- High Syntax score, use of DES, 1 vs 2 stent technique did not predict MACE at 3 years.
Discussion
- There is small number of subjects
- However, this has a long follow up period
- Lower rate of re-look angiogram
- This implies that there was low clinical events
- Overall MACE in elective arm was low
- There was only 1 case of ISR requiring revascularization
CONCLUSION
- The incidence of adverse events associated with unprotected left main coronary artery stenting is low
- Mitigated by better stent technology, better antithrombotic options, imaging adjuncts
- Predictors of adverse events in our centre are the use of IABP (cardiogenic shock) and presence of low ejection fraction