Abstract:

Aim: was to determine the influence of blood plasma fibrinogen level on results of the left main coronary artery stenting.

Material and methods: clinical, laboratory and angiographic parameters of 819 patients after elective stenting of the unprotected left main coronary artery were used. The end-point was target lesion failure (TLF), including adverse events as repeated revascularization of the target lesion (TLR), myocardial infarction (MI) and death from cardiac causes.

Results: in 5 years follow-up period, end-point was achieved in 158 cases (19,3%). Independent predictors of TLF were: SyntaxScore > 32 (HR 1,089 95% CI 1,029-1,153, p = 0,003), creatinine level (HR 1,009 95% CI 1,004-1,013, p=0,001) and fibrinogen level (HR 1,4 95% CI 1,169-1698, p=0001). According to results of the Kaplan-Meier analysis, the cumulative probability of the TLF was higher in patients with fibrinogen values greater than 3,48 g/L (log-rank 0,001).

Conclusion: blood plasma fibrinogen level was an independent predictor of the TLF after left main coronary artery stenting. Increase in the level of blood fibrinogen for each 1 g/L led to an increase in the risk of TLF by 1,4 times per month.

References 

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Abstract:

Importance: despite generally promising outcomes after stenting for unprotected left main coronary artery (ULMCA) disease, the ULMCA bifurcation lesions remain challenging, and their restenosis rate is still relatively high.

Objective: aim of the current study was to analyze possible factors influencing one year MACE rate in distal ULMCA patients.

Design, setting and patients: from year 2002 until end of year 2011 at Latvian Centre of Cardiology Pauls Stradins Clinical University hospital in ULMCA registry 1052 patients were enrolled. Interventions: In 723 patients distal bifurcations were treated, out of them in 449 patients one year follow-up were completed and those patients were included in current analyses Main outcome measures: cardiac death, target vessel revascularization (TVR), target lesion revascularization (TLR), major cardiac adverse events (MACE) were assessed at one year.

Results: two stent technique was used in 8,5% of cases. MACE, cardiac death, TVR and TLR rates at one year was 15,6%, 2,9%, 4,7% and 12,9%, respectively Cardiac death was associated with diabetes mellitus and NSTEMI, however, TLR was associated with SYNTAX score >30. MACE was associated with NSTEMI and 2 stent technique. True bifurcation was not associated with adverse cardiovascular outcomes.

Conclusions: Use of two stent technique and NSTEMI at presentation were associated of MACE at one year in distal ULMCA patients. 

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