Treatment of unprotected left main disease with drug-eluting stents in patients at high risk for coronary artery bypass grafting

Cardiovasc Revasc Med. 2007 Apr-Jun;8(2):84-9. doi: 10.1016/j.carrev.2006.11.007.


Background: Percutaneous coronary intervention (PCI) for high-grade stenosis of the left main coronary artery with bare-metal stents has been limited by restenosis, and most patients are managed with coronary artery bypass grafting (CABG). Recently, drug-eluting stents (DES) have reduced instent restenosis after PCI, but their role in the treatment of left main disease remains unclear.

Aims: The aim of this study was to determine the outcomes after utilizing DES to treat left main disease.

Methods: Twenty consecutive symptomatic patients with >50% angiographic stenosis of the left main coronary artery with no prior history of CABG ["unprotected left main" (ULM)] underwent PCI with DES. Patients were divided into two groups based on the presence (Group A, n=5) or absence (Group B, n=15) of preprocedural cardiogenic shock. At follow up (median, 14 months), cumulative major adverse cardiac events (MACE-death, myocardial infarction, or target vessel revascularization) were determined.

Results: Sixteen (80%) of 20 patients were at high risk for CABG because of comorbidity, advanced age, or cardiogenic shock. Procedural success was 100% (20/20). Three of five patients in Group A (60%) died in hospital and the two surviving patients experienced no MACE at follow up. In Group B (n=15), there was no in-hospital MACE, but one patient died suddenly 8 weeks postprocedure [cumulative MACE of 7% (1/15)].

Conclusions: Our study demonstrates the feasibility of ULM treatment with DES with acceptable medium-term outcomes. While CABG remains the best form of revascularization for the majority of patients with ULM, DES should be considered in those who are at high risk.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon, Coronary / adverse effects
  • Angioplasty, Balloon, Coronary / instrumentation*
  • Cardiovascular Agents / administration & dosage*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Coronary Angiography
  • Coronary Artery Bypass / adverse effects*
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / mortality
  • Coronary Stenosis / surgery
  • Coronary Stenosis / therapy*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Selection*
  • Prospective Studies
  • Prosthesis Design
  • Research Design
  • Risk Assessment
  • Severity of Illness Index
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / mortality
  • Stents*
  • Time Factors
  • Treatment Outcome


  • Cardiovascular Agents