Impact of interventional strategy for unprotected left main coronary artery percutaneous coronary intervention on
Ralf Lehmann1, Joachim R Ehrlich, Salvatore De Rosa
1Department of Cardiology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany. ralf.lehmann@em.uni-frankfurt.de
Insights
Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) bifurcation lesions requires careful strategy. A single-stent approach without side branch intervention may increase long-term mortality risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (ULMCA) is a feasible procedure.
- Optimal interventional strategies for ULMCA lesions involving the left anterior descending-left circumflex bifurcation remain unclear.
- Previous randomized trials have excluded ULMCA lesions, limiting evidence-based guidance.
Purpose of the Study:
- To evaluate the impact of different interventional strategies on long-term survival in patients undergoing PCI of ULMCA.
- To compare the outcomes of ULMCA PCI involving bifurcations versus isolated ULMCA lesions.
Main Methods:
- Retrospective analysis of a single-centre registry of 102 patients undergoing ULMCA stent PCI.
- Evaluation of interventional protocols and procedural angiograms.
- Multivariable Cox regression analysis to assess factors influencing long-term survival.
Main Results:
- Most interventions (83/102) involved the left main bifurcation.
- A single-stent strategy for bifurcation without side branch intervention was associated with significantly less-favourable long-term survival (HR 4.08).
- Drug-eluting stents were used in 96% of patients, with a mean follow-up of 3.4 years.
Conclusions:
- Single-stent PCI of ULMCA bifurcations without side branch intervention may be linked to higher long-term mortality.
- ULMCA PCI involving bifurcations can achieve results comparable to isolated ULMCA shaft or ostium PCI.
- Large, randomized trials are necessary to determine the optimal technical approach for ULMCA interventions.
Background:
Percutaneous coronary intervention (PCI) of unprotected left main coronary artery (ULMCA) is feasible. In cases involving the left anterior descending-left circumflex bifurcation, the optimal interventional strategy remains unclear. Randomized bifurcation trials in the past excluded ULMCA lesions.
Methods:
A single-centre registry study with retrospective analysis of the interventional protocols and procedural angiograms of 102 patients who underwent stent PCI of ULMCA was performed in order to evaluate the impact of the interventional strategy on long-term survival.
Results:
Isolated stenting of the ostium or mid ULMCA without bifurcation stenting was performed in 19 patients. Most interventions (n = 83) involved the left main bifurcation. Distal or bifurcation lesions were treated by provisional T-stenting in cases of single involved ostium (left anterior descending or right circumflex) or systematic T-stenting or V-stenting if both proximal coronary arteries were involved (n = 19). The majority (96%) of patients received drug-eluting stents. The long-term survival (mean follow-up = 3.4 ± 1.7 years) of patients was influenced by the interventional strategy. A single-stent strategy involving the bifurcation without side branch intervention was associated with less-favourable long-term survival (hazard ratio 4.08; 95% confidence interval, 1.91-8.69; multivariable Cox regression analysis).
Conclusions:
This prospective observational study suggests that single-stent PCI involving the bifurcation without side branch intervention of ULMCA is possibly associated with higher long-term mortality. ULMCA-PCI involving the bifurcation is possible with similar results compared with isolated PCI of ULMCA shaft or ostium. Large, randomized trials are warranted for comparison of optimal technical approach to LMCA interventions.
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