Abstract 19241: Evolving Techniques and Outcomes in Left Main Pci With Des

Abstract

Objective: To evaluate the impact of technical evolutions on clinical outcomes for patients undergoing percutaneous coronary intervention (PCI) with drug eluting stent (DES) for left main (LM) disease. Background: PCI techniques and materials are improving. Those evolutions could have a positive clinical impact for patients undergoing PCI for LM disease. Methods: We compared baseline characteristics, procedural and clinical outcomes in 601 consecutive patients undergoing PCI for LM stenosis with DES from 2004 to 2009. Patients were analyzed in 3 separate groups according to the PCI timing: 2004/2005 (group 1); 2006/2007 (group 2); 2008/2009 (group 3). The primary outcome was death at 1-year. Results: Comparing to 2004/2005, patients undergoing PCI in 2008/2009 were at higher risk (Logistic Euroscore 8.4±0.7% in group 3 vs. 7.4±0.6% in group 1; p=0.045). The radial approach was increasingly used (28.2% in 2004/2005; 34.2% in 2006/2007 and 61.4% in 2008/2009; p<0.0001), a predilation was more frequently performed (32.1% in 2004/2005; 42.7% in 2006/2007 and 45.8% in 2008/2009; p=0.046) and a second generation DES was more frequently used (38.2% in group 3 vs. 0% in group 1; p<0.0001). The stent diameter significantly increased with time (3.5±0.02mm in group 1; 3.6±0.02mm in group 2; 3.7±0.02mm in group 3; p<0.0001) and a post dilation was more often performed (32.1% in group 1; 37.9% in group 2; 46.4% in group 3; p=0.021). One-year mortality is significantly decreasing with time (9.9% in 2004/2005; 8.9% in 2006/2007; 4.1% in 2008/2009; p=0.028), and this difference is driven by fewer deaths in patients treated for distal LM (13.2% in 2004/2005; 8.6% in 2006/2007; 4.2% in 2008/2009; p=0.033). Conclusion: In this observational study, clinical outcome are improving for patients undergoing LM PCI with DES, because of fewer death at one year for patients with a distal LM lesion.