Long-term outcomes after percutaneous coronary intervention of unprotected left main coronary disease with drug-eluting stents

Abstract

Most available data indicates that stenting for unprotected left main coronary artery disease (ULMCA) with drug-eluting stents (DES) is safe and effective. At present, surgery is considered the gold standard for optimal revascularization. The aim of this study was to evaluate the short and long term outcome of patients with ULMCA stenosis who underwent percutaneous coronary intervention (PCI) with DES implantation in a single center. Coronary stents were implanted into ULMCA in 59 patients. Short and long term total mortality and main adverse cardiac events (MACE): cardiac death, myocardial infarction and additional target lesion or non-target lesion revascularization (TLR) were assessed. Mean age was 69 ± 13 (29% were females). 23% were emergency/urgent cases. Angiographic and clinical success of PCI was 100%. 8.5% of the cohort underwent Transcatheter aortic valve implantation for severe inoperable aortic stenosis. 52% have significant distal left main disease requiring two stent bifurcation techniques. Follow-up duration was 23 ± 13 months. In hospital MACE occurred in 10%. In hospital death occurred in 3.4%. Long term total mortality was 11.8%. 3.3% of the cohort died because of non-cardiac problem. Using ARC (academia and research consortium) definition, probable acute stent thrombosis occurred in 5% of the cohort, all of them underwent two stent bifurcation techniques. Considering high risk characteristics of the study group, ULM stenting is feasible, with probably reasonable short and long term outcomes; however, ULM stenting requiring two stent bifurcation techniques should be reserved for patients who are not appropriate surgical candidates.