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Long term clinical outcomes in DES implantation for unprotected left main disease

F Conrotto1, M D'amico, E Ebrille

  • 1San Giovanni Battista Molinette Hospital, Turin, Italy. federico.conrotto@gmail.com

Minerva Cardioangiologica
|May 18, 2013
PubMed

Insights

Long term follow-up of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main coronary artery (ULMCA) disease shows good results. Stent postdilation was found to be protective against major adverse cardiac events and target vessel revascularization.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Research
  • Medical Device Technology

Background:

  • Unprotected left main coronary artery (ULMCA) disease poses significant risks.
  • Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is an alternative to surgery.
  • Long-term outcomes of DES in ULMCA require further investigation.

Purpose of the Study:

  • To conduct a long-term follow-up of patients undergoing PCI with DES for ULMCA disease.
  • To evaluate the impact of clinical and procedural factors on long-term outcomes.
  • To identify predictors of adverse events after ULMCA PCI.

Main Methods:

  • Retrospective analysis of 97 consecutive patients treated with DES (sirolimus or paclitaxel) for de novo ULMCA lesions.
  • Mean follow-up duration of 3 years (range 1-6.7 years).
  • Assessment of technical success, procedural success, and major adverse cardiac events (MACE) including cardiac death, reinfarction, target vessel revascularization (TVR), target lesion revascularization (TLR), and stent thrombosis (ST).

Main Results:

  • 100% technical and 95.9% procedural success rates.
  • Long-term event rates: cardiac death 6.1%, reinfarction 6.1%, TVR 17.5%, TLR 4.2%, definite ST 1%, possible ST 4.2%.
  • Stent postdilation (performed in 49.5% of patients) was the only factor significantly associated with lower MACE (25% vs. 46.9%) and TVR (8.3% vs. 26.5%) in multivariate analysis.

Conclusions:

  • Long-term follow-up demonstrates favorable clinical outcomes for PCI with DES in ULMCA disease.
  • Stent postdilation appears to play a protective role in reducing adverse events after DES implantation in ULMCA.
  • These findings support the consideration of postdilation as a key procedural step in ULMCA PCI.
Abstract

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