First Percutaneous Catheter Intervention for Left Main Coronary Artery Disease: 30 Years Ago
Shahbudin H. Rahimtoola, MB, FRCP, MACP, MACC, DSc (Hon)*
At this time when we celebrate the birth of JACC: Cardiovascular Interventions, it is worth remembering that the first angioplasty for left main coronary artery disease (CAD) was performed 30 years ago by Andreas Gruentzig.
Gruentzig described the first 5 cases of percutaneous catheter intervention (PCI) in awake humans in a Letter to the Editor (1) (Fig. 1). Although the legend to the figure stated "Details of patient 3," it was actually "patient 4" (2) who was 43 years old and had 80% stenosis of the main left coronary artery (LCA), and the angioplasty was performed at University Hospital, Frankfurt, on November 24, 1977. Gruentzig agreed about the typographical error and, importantly, presented data that confirmed that the isolated main LCA lesion was not due to vasospasm (3). The early result of the angioplasty was excellent. In a subsequent report of his first 50 patients (4), Gruentzig described 2 patients who had PCI for main LCA disease; this was prior to the stent era.
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Figure 1 PCI on Awake Human
(A) Eighty percent stenosis of main left coronary artery; (B) passage of the dilatation catheter; (C) post-procedure angiogram. Reprinted with permission from Elsevier (The Lancet, 1978, 1, 1093).
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The "late" outcome of that first patient is of interest. Several years later at a national meeting, Gruentzig told me the patient had died suddenly about 1 year after the procedure. The patient was in another country. Gruentzig told me if he was able to learn of the cause of death, he would share the information with me; he died shortly thereafter. In the 1970s, trauma to the main LCA from cannula placed in the main LCA for continuous coronary perfusion during open-heart surgery was known to cause myocardial infarction (5), angina, and "late" sudden death if the late occlusion was not recognized in time and the coronary arteries were not bypassed. That surgical practice has been long discontinued or, if used, great care and attention is paid to cannulating the main LCA.
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Editor’s Note
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Gruentzig presented this case at the 1977 AHA Scientific Session. The ovation was so prolonged he could barely finish the talk. Now 30 years later we are still wondering if left main disease can be safely treated with PCI. The SYNTAX trial results will help.
Spencer B. King III, MD, MACC Editor-in-Chief, JACC: Cardiovascular Interventions
* Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, LAC+USC Medical Center, University of Southern California, 2025 Zonal Avenue, GNH 7131, Los Angeles, California 90033-1034
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REFERENCES
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- Gruentzig A. Transluminal dilatation of coronary-artery stenosis(letter) Lancet 1978;1:263.[CrossRef][Web of Science][Medline]
- Murphy E, Rahimtoola SH. Transluminal dilatation coronary artery stenosis(letter) Lancet 1978;1:1093.[Web of Science][Medline]
- Gruentzig A. Reply Lancet 1978;1:1093.[Web of Science][Medline]
- Gruentzig AR, Senning A, Siegeuthaler WE. Non-operative dilatation of coronary artery stenosis. Percutaneous transluminal coronary angioplasty. N Engl J Med 1979;301:61-68.[Web of Science][Medline]
- Murphy ES, Rösch J, Rahimtoola SH. Frequency and significance of coronary arterial dominance in isolated aortic stenosis Am J Cardiol 1977:505-509.
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