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Long-term follow-up after nonurgent percutaneous coronary intervention in unprotected left main coronary arteries

Marcel A M Beijk1, Saskia Z H Rittersma, Karel T Koch

  • 1Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|June 3, 2010
PubMed

Insights

Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis shows good long-term outcomes, with most events in the first year. Low surgical risk patients had better survival than high-risk patients.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Surgery
  • Clinical Outcomes Research

Background:

  • Coronary artery bypass grafting (CABG) is guideline-recommended for unprotected left main coronary artery (ULMCA) stenosis.
  • Limited data exist on long-term outcomes for PCI in ULMCA stenosis, especially for Heart Team-selected patients.

Purpose of the Study:

  • To evaluate long-term outcomes of percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis.
  • To compare outcomes between patients at low versus high surgical risk for coronary artery bypass grafting (CABG).

Main Methods:

  • A cohort of 227 patients undergoing PCI for ULMCA stenosis between 1996-2007 was analyzed.
  • Patients were selected by a local Heart Team, considering patient/physician preference.
  • Follow-up extended up to 8 years, with data collected at 1 year and in November 2008.

Main Results:

  • The composite endpoint of cardiac death, myocardial infarction (MI), or target lesion revascularization (TLR) occurred in 14.8% at 1 year, 18.3% at 3 years, and 20.9% at 5 years.
  • Patients at low surgical risk had significantly lower rates of cardiac death or MI compared to high-risk patients (1.4% vs. 16.8% at 8 years).
  • No significant difference in the composite of cardiac death, MI, or TLR was observed between low and high surgical risk groups (18.6% vs. 24.4%).

Conclusions:

  • PCI for ULMCA stenosis in Heart Team-selected patients yields favorable long-term clinical outcomes, with events primarily within the first year.
  • Long-term survival is significantly better for patients deemed at low surgical risk for CABG compared to those at high risk.
Abstract

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