The purpose of this study was to investigate the predictor of long-term outcomes in patients after stent implantation for unprotected left main coronary artery (LMCA) disease. Coronary stenting has recently been advocated as an alternative procedure for LMCA disease. Information on the predictors of long-term outcomes in patients after stent implantation for unprotected LMCA disease is not clear. Seventy six patients (51 men and 25 women, age 68 ± 10 years) with medically refractory angina received coronary stenting for unprotected LMCA disease. During a follow-up period of 40 ± 26 months, 7 patients (9%) died because of cardiovascular disease in 5 (7%) and noncardiovascular disease in 2 (3%). In the other 69 patients, 19 patients (25%) needed repeated percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG). In a univariate analysis, only female sex was related to the repeated PCI and/or CABG (P = 0.04). A history of cerebral vascular attack (CVA) (P = 0.005), anemia (P = 0.03) and lower left ventricular ejection fraction (LVEF) (P = 0.008) were related to the cardiovascular mortality. A history of myocardial infarction (P = 0.03), a history of CVA (P = 0.02), anemia (P = 0.02), and lower LVEF (P = 0.002) were related to the total mortality. In a multivariate analysis, female sex (P = 0.007; odds ratio 5.29, 95% confidence interval [CI] 1.57–17.80) and young age (P = 0.025; odds ratio 3.92, 95% CI 1.19–12.98) could predict the repeated PCI and/or CABG. Only a history of CVA could predict the cardiovascular mortality (P = 0.027; odds ratio 34.18, 95% CI 1.49–783) and only lower LVEF could predict the total mortality (P = 0.027; odds ratio 13.26, 95% CI 1.34–131). Female sex and young age could predict the repeated PCI and/or CABG in patients after stent implantation for unprotected LMCA disease. Furthermore, a history of CVA could predict the cardiovascular mortality and lower LVEF could predict the total mortality.

Left main coronary artery (LMCA) disease is now uniformly treated with coronary artery bypass grafting (CABG). However, some patients with LMCA disease do not receive CABG because of high operative risks. The advent of stent implantation has permitted a non-operative improvement in myocardial blood flow in many patients with single- and multi-vessel coronary artery disease. However, the outcomes of stent implantation for unprotected LMCA disease are still unclear. Stent implantation was performed for unprotected LMCA disease in 13 patients; eight patients had high operative risk and five patients had refused CABG. The primary success rate was 100% (13/13 patients). One patient (8%) developed a non-Q-wave myocardial infarction after LMCA stenting. Repeat angiography was obtained in five patients (38%) with recurrent angina, and three patients (23%) received repeated percutaneous transluminal coronary angioplasty (PTCA) for LMCA restenosis. In the follow-up period of 18+/-3 months, 12 patients (92%) remained in satisfactory condition with no further need for surgical intervention. One patient (8%) ultimately required CABG, and she died after CABG at 3 months after LMCA stenting. In conclusion, although CABG remains the standard treatment for LMCA disease, the present study demonstrates that stent implantation is a safe and clinically beneficial revascularization procedure for unprotected LMCA disease in patients who have high operative risk as well as those who refuse CABG.

BACKGROUND:Atrial fibrillation occurs in 10% to 40% of patients who undergo coronary artery bypass grafting. This prospective study assesses the safety and efficacy of low-dose intravenous amiodarone in the prevention of atrial fibrillation after coronary artery bypass grafting. METHODS:One hundred forty patients were randomly divided into two groups: an amiodarone group (n = 74) receiving intravenous amiadarone in a loading dose of 150 mg and maintenance dose of 0.4 mg x kg(-1) x h(-1) for 3 days before and 5 days after operation and a control group (n = 76) receiving matching infusions of 5% glucose solution. RESULTS:Atrial fibrillation occurred in 9 (12%) of the amiodarone group patients and in 26 (34%) of the control group patients during hospitalization (p < 0.01). The maximum ventricular rate during atrial fibrillation was significantly slower in the amiodarone group (107 +/- 21) than in the control group (138 +/- 24 beats per minute, p < 0.01). The duration of atrial fibrillation in the amiodarone group (1.1 +/- 1.2 hours) was significantly shorter than that in the control group (3.2 +/- 1.3 hours, p = 0.01). The two groups had no significant differences in incidence of major morbidity (8 of 74 versus 8 of 76 in amiodarone and control groups, respectively) or mortality (4 of 74 versus 5 of 76). However, the control group had significantly longer intensive care unit stays (132 +/- 24 versus 111 +/- 19 hours, p < 0.01). CONCLUSIONS:Perioperative low-dose intravenous amiodarone significantly reduces the incidence, ventricular rate, and duration of atrial fibrillation after coronary artery bypass grafting. Furthermore, low-dose intravenous amiodarone is well tolerated and does not increase the risk of intraoperative or postoperative complications.

Coronary artery bypass grafts (CABG) and medical treatment were used to be the choices for most patients with left main coronary artery (LMCA) disease. CABG was a relative credible treatment and the average survival period could extend more than ten years. CABG has been considered more beneficial compared to medical treatment. After many years of development in the area of medical devices, bare metal stents (BMS) were invented. The BMS becomes more flexible and easier to deliver to the narrowing part of the vessel. Many latest studies showed that stent implantation is a potential treatment for patients with LMCA disease. In this study, 105 patients was collected (78 men and 27 women, age 68±10 years) from May 1997 to June 2005 whom underwent stent implantation for LMCA disease in Shin Kong Wu Ho-So Memorial Hospital Each patient was selected according to two criteria: 1. Patient who can not accept operation because of other disease (cancer, stroke, renal dysfunction, lung dysfunction, and old age). 2. Patient refused CABS. The present study showed that female and young age groups show higher accuracy prediction of the repeated PCI and/or CABG after stunt implantation for LMCA disease. In addition, history of CVA could help predict the cardiovascular mortality and comparing lower LVEF could predict the total mortality. The conclusion will provide the interventional cardiologists and these patients as a valuable consultation for treatment.