Long-Term Clinical Outcomes of Unprotected Left Main Percutaneous Coronary Intervention: A Large Single-Centre Experience.

Yuejin Yang,Min Yao,Kefei Dou,Wei Yang ,Chao-Wei Mu ,Jue Chen,Jilin Chen,Ying Song,Fenghuan Hu,Yongjian Wu,Bo Xu,Jinqing Yuan,Haibo Li ,Jun Dai,Yi‐Da Tang ,Shubin Qiao,Changdong Guan,Zhan Gao,Runlin Gao,Hong Qiu,Xue-Wen Qin ,Lijian Gao,Jie Qian

doi:10.1155/2021/8829686

Abstract

Aims This study sought to report the 10-year clinical outcomes of patients who underwent unprotected left main (LM) percutaneous coronary intervention (PCI) in a large centre. Methods and Results A total of 913 consecutive patients who underwent unprotected LM PCI from January 2004 to December 2008 at Fu Wai Hospital were retrospectively analysed; the mean age was 60.0 ± 10.9 years, females accounted for 22% of patients, diabetes was present in 27.7% of patients, and an LM bifurcation lesion occurred in 82.9% of patients. During the median follow-up of 9.7 years, major adverse cardiac or cerebrovascular events (MACCEs) occurred in 25.6% (234) of patients, and the rates of all-cause death, myocardial infarction, and stroke were 14.9%, 11.0%, and 7.1%, respectively. Cardiac death occurred in only 7.9% of patients. The estimated event rate was 41.9% for death/myocardial infarction/any revascularization and 45.9% for death/MI/stroke/any revascularization. Definite/probable stent thrombosis occurred in 4.3% (39) of patients. According to the subgroup analysis, IVUS-guided PCI was associated with less long-term MACCEs. Further multivariate analysis identified that age and LVEF<40% were the only independent predictors for 10-year death. Age, LVEF<40%, creatinine clearance, and incomplete revascularization were independent predictors for death/MI, while a two-stent strategy, diabetes, a transradial approach, and the use of bare metal stents (BMSs) or first-generation drug-eluting stents (DESs) were not. Conclusions Unprotected LM PCI in a large cohort of consecutive patients in a single large centre demonstrated favourable long-term outcomes up to 10 years even with the use of BMSs and first-generation of DESs.

Highlights

Randomized controlled trials comparing the effect of percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) still have not reached consistent results in patients with unprotected left main (LM) coronary artery disease (CAD) [1, 2], PCI has always been recommended as an effective treatment for patients with unprotected LM CAD by guidelines [3, 4] and has been performed in daily practice, except in bifurcated lesion and the twostent strategy [5]
A total of 913 LM PCI patients with the mean age of 60.0 ± 10.9 years were enrolled; females accounted for 22.0% of patients, diabetes was present in 27.7% of patients, and unstable angina was present in 60.4% of patients
An LM bifurcation lesion was present in 82.9% of patients, LM plus 3-vessel disease was present in 36.1% of patients, and the mean left ventricular eject fraction (LVEF) was 62.5 ± 7.9%

Summary

Introduction

During the last 2 decades, therapeutic advancements including drug-eluting stents (DESs) [6,7,8,9,10,11] and invasive imaging tools such as intravascular ultrasound (IVUS) [12,13,14,15,16,17] have largely improved PCI outcomes in patients with unprotected LM disease. Clinical or technique factors that influence long-term outcomes following LM are still controversial. In this circumstance, we retrospectively collected over 900 consecutive LM patients with detailed patient demographics, lesion, and procedural information who underwent LM PCI at a large cardiac centre with as long as a 10-year follow-up duration

Methods

Results

Conclusion