Korean Circ J.  2007 Mar;37(3):108-112. 10.4070/kcj.2007.37.3.108.

Risk Factors Associated with Hemodynamic Instability during Stent Implantation in Unprotected Left Main Lesions without Routine IABP: Identification of the High Risk Patients

• Kim W
• Lee SH
• Hong GR
• Shin DG
• Kim YJ
• Shim BS
• Cho YK
• Kim HS
• Nam CW
• Hur SH
• Kim YN
• Kim KB
• Seol SH
• Yang TH
• Kim DK
• Kim SM
• Kim DI
• Kim DS

• KMID: 2227081
• DOI: http://doi.org/10.4070/kcj.2007.37.3.108

Abstract

BACKGROUND AND OBJECTIVES: Percutaneous coronary intervention (PCI) of unprotected left main coronary artery (LMCA) stenosis is a promising approach during this era of drug-eluting stents. However, there is no available hemodynamic data on these type patients during the performance of LMCA stenting. The purpose of this study was to determine the risk factors affecting hemodynamic stability during LMCA stenting, and to evaluate whether hemodynamic support such as inotropics or intra-aortic balloon pump (IABP) is needed, based on the risk factors.
SUBJECTS AND METHODS
From July 2003 to January 2006, we enrolled 92 study patients (Male=55) who had visited Yeungnam University Hospital, Keimyung University Dongsan Hospital and InJe University Baik Hospital in Busan and they were all were diagnosed with angiographically detected unprotected LMCA stenosis. Group 1 (n=69) included those patients who did not need hemodynamic support during PCI. Group 2 (n=23) included patients who needed hemodynamic support during PCI. All patients had stents deployed in the LMCA lesions without hemodynamic support; the clinical, angiographic and procedural outcomes were compared between the two groups after the procedure.
RESULTS
The baseline patient characteristics were not statistically different between the two groups. On univariate analysis, Group 2 had more patients diagnosed with acute myocardial infarction (AMI) than Group 1 (40% vs. 15%, respectively, p=0.014). Group 1 had a greater frequency of an increased left ventricular (LV) ejection fraction than Group 2 (60+/-10 vs. 47+/-11, respectively, p=0.01). Regarding the lesion location in the LMCA, Group 2 had relatively more lesions at bifurcated locations than Group 1 (44% vs. 78%, respectively, p=0.004). Group 2 required more complex techniques to repair lesions, such as kissing or crush stenting, than did Group 1 (19% vs. 48%, respectively, p=0.006). Multivariate logistic regression analysis showed that the presence of AMI (Odds Ratio (OR)=3.74, p=0.014), a complex stenting procedure such as kissing or crushing (OR=3.99, p=0.006), a bifurcated lesion (OR=4.58, p=0.004) and poor LV function (OR=9.95, p=0.0001) were independent risk factors for hemodynamic instability during LMCA stenting.
CONCLUSION
The most important risk factor for hemodynamic instability during LMCA stenting was LV function. Therefore, preparation for hemodynamic support, including IABP before the procedure, is necessary for the high risk patients.

Keyword

Coronary arteres; Hemodynamic processes, risk factors; Ventricular function

MeSH Terms

Busan
Constriction, Pathologic
Coronary Vessels
Drug-Eluting Stents
Hemodynamics*
Humans
Logistic Models
Myocardial Infarction
Percutaneous Coronary Intervention
Risk Factors*
Stents*
Ventricular Function

Figure

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  Fig. 1 The risk factors and odds ratio for hemodynamic instability during left main coronary artery stenting. The identified risk factors were the presence of acute myocardial infarction (AMI), use of complex stenting techniques (kissing or crushing), the lesion location (bifurcated lesion) and poor left ventricular (LV) function (especially a left ventricular ejection fraction (LVEF) <45%); the odds ratio for poor LV function was the most significant predictive factor.

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