Left main PCI with second-generation DES: a single-centre experience

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background To characterise patients and procedures with left main (LM) percutaneous coronary intervention (PCI) and to evaluate their outcomes. Methods Single-centre, retrospective study performed from January 2018 to December 2019 in patients with LM PCI with second-generation drug-eluting stents (n = 104). Indications for PCI were elective PCI for stable angina (n = 39), stabilised NSTEMI (n = 27), NSTEMI with ongoing instability (n = 8), STEMI (n= 24), and non culprit lesion treatment after primary PCI for STEMI(n = 6). 25.7% of patients were in cardiogenic shock. After our first LM PCI guided with intracoronary imaging, 68.5% of the procedures were performed with it. Results Patients with LM PCI were mainly male (78.1%) with a median age of 66.7 years. 53.3% of patients were diabetic and 62% had reduced ejection fraction. Previous CABG was presented in 25.7% (only patients had unprotected LM). The SYNTAX score was low (<22) in 58.6%, intermediate (22 to 32) in 32.2% and high (>33) in 9.2%. Distal LM bifurcation PCI was performed in 83.4%, and 67% of patients had two-vessel or three-vessel disease. 43.1% of patients with distal disease were treated with a double-stent technique [DST] (1 with T-stent, 2 with TAP, and 4 with culotte technique), in which proximal optimisation technique (POT) and kissing balloon (KB) were always performed (fig.-1). When single-stent technique [SST] was used in distal LM, POT was performed in 96.0% and kissing balloon in 85%. Pre- and post-dilatation were performed in 93.0 and 98.1% of all cases, respectively. 6.7% of patients died during the hospitalisation (2 with stent thrombosis; 5 were in cardiogenic shock). All patients had at least 1-year of follow-up. At follow-up, 8.9% of patients died. 76.5% of deaths were non-cardiovascular; cardiovascular deaths were due to heart failure. Non-fatal myocardial infarction occurred in 9.8% patients with 2 patients undergoing unplanned PCI (one with LM PCI). Target lesion failure occurred in 8 patients (2 had fatal stent thrombosis; 4 had stent restenosis; 1 were sent to CABG and 1 was treated with PCI). 4 patients had a stroke during hospitalisation and another during follow-up. Conclusions LM PCI can be considered as an alternative revascularisation in urgent situations when surgery cannot be considered. Though it can be a high-risk subset, the results in our population are encouraging.