Five-year outcomes and late adverse events after sirolimus-eluting stent implantation for unprotected left main coronary artery disease

Abstract

Background: The clinical guideline for unprotected left main (LM) disease has been updated and percutaneous coronary intervention (PCI) for LM disease has become a common procedure in daily clinical practice. Long-term clinical outcome, however, has not been adequately addressed yet, especially late adverse events beyond 1 year after stent implantation for LM disease. Methods and results: We evaluated long-term clinical outcome including late adverse events beyond 1-year after LM-PCI in consecutive 134 patients who received unprotected LM stenting with sirolimus eluting stents (SES) at Kyoto university hospital between September, 2004 and December, 2009. The mean clinical follow-up period of this study was 4.0±1.8 years. Late Adverse events were defined as sudden cardiac death, target-vessel myocardial infarction (MI), emergent revascularization for LM disease, and acute congestive heart failure (ACHF), which occurred beyond 1 year after stent implantation. The cumulative incidence of all-cause death, cardiac death, and target-lesion revascularization (TLR) for LM disease was 26.5%, 8.1%, and 12.9%, at 5 years after LM-PCI, respectively. The cumulative incidence of cardiac death was significantly higher in patients with 2 stenting technique compared to those with single stenting. Late adverse events were occurred in 6 patients. There are no late adverse events in patients with non-bifurcation LM disease at initial procedure. View this table: Table 1. Late adverse events Conclusions: Five-year clinical outcome of SES implantation for unprotected LM disease was relatively favorable and the risk of late adverse events seemed to be an acceptable range. However, the high risk patient for late adverse events, such as those with true bifurcation lesion and receiving complex stenting, seems to require close observation.