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Published on: May 14, 2013
Very long-term outcomes after percutaneous coronary intervention with bare metal stents for unprotected left main
Akihiro Nomura1, Kyohei Yamaji, Shinichi Shirai
1Division of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka. Japan. nomuryn@gmail.com
Insights
Bare metal stents (BMS) show feasibility for unprotected left main coronary artery disease (ULMCAD) up to 10 years. Left main trunk diameter and SYNTAX score predict outcomes after BMS PCI for ULMCAD.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Unprotected left main coronary artery disease (ULMCAD) poses significant risks.
- Percutaneous coronary intervention (PCI) with bare metal stents (BMS) is a treatment option for ULMCAD.
- Long-term outcomes of BMS for ULMCAD require further evaluation.
Purpose of the Study:
- To assess very long-term clinical outcomes after PCI with BMS for ULMCAD.
- To identify predictors of clinical outcomes in patients with ULMCAD treated with BMS.
Main Methods:
- Retrospective analysis of 151 patients undergoing PCI with BMS for ULMCAD (March 1991-August 2001).
- Median follow-up of 10.5 years.
- Patient-oriented major adverse cardiac events (MACE) defined as all-cause death, myocardial infarction (MI), or coronary revascularization.
Main Results:
- At 10 years, incidences were: cardiac death 11.1%, target lesion revascularization (TLR) 25.2%, and patient-oriented MACE 81.9%.
- Pre-reference diameter of the left main trunk (LMT) was associated with TLR (aHR 0.28, p<0.001).
- SYNTAX score independently predicted patient-oriented MACE (aHR 1.03, p=0.009).
Conclusions:
- Left main trunk diameter and SYNTAX score are significant predictors of outcomes in ULMCAD treated with BMS.
- BMS implantation for larger ULMCAD with lower SYNTAX scores is feasible with favorable outcomes up to 10 years.
Aims:
The aim of this study was to evaluate very long-term clinical outcomes and potential predictors after percutaneous coronary intervention (PCI) with bare metal stents (BMS) for unprotected left main coronary artery disease (ULMCAD).
Methods And Results:
From March 1991 to August 2001, 151 patients who underwent PCI with BMS for ULMCAD were investigated retrospectively. The patient-oriented major adverse cardiac events (MACE) were defined as the occurrence of all-cause death, any MI, and any coronary revascularisation. The median follow-up duration was 10.5 years. The mean age was 69.9±11.5 years, and 106 patients (70.2%) were male. At 10 years, the incidences of cardiac death (CD), target lesion revascularisation (TLR) and patient-oriented MACE were 11.1%, 25.2% and 81.9%, respectively. In multivariate analysis, the pre-reference diameter of the left main trunk (LMT) was significantly associated with TLR (adjusted hazard ratio [HR] [95% confidence interval (CI)], 0.28 [0.14-0.54], p<0.001) and the SYNTAX score remained an independent predictor of patient-oriented MACE (adjusted HR [95% CI], 1.03 [1.007-1.05], p=0.009).
Conclusions:
The pre-reference diameter of LMT was significantly associated with TLR, and the SYNTAX score significantly predicted the risk of patient-oriented MACE at 10 years. BMS implantation for larger size of ULMCAD with a lower SYNTAX score was feasible for up to 10 years.
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