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Long-term outcome of unprotected left main stenting: a Canadian tertiary care experience
Matthew Sibbald1, William Chan1, Paul Daly1
1Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
Insights
Unprotected left main stenting in Canada showed acceptable short-term outcomes but poor long-term survival. Higher SYNTAX scores and bare-metal stents correlated with increased death rates in this high-risk patient group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Unprotected left main coronary artery disease (ULMD) stenting is increasingly utilized.
- Limited Canadian data exists on long-term outcomes outside clinical trials.
Purpose of the Study:
- To evaluate the long-term outcomes of unprotected left main stenting in a Canadian population.
- To identify factors associated with adverse events after ULMD stenting.
Main Methods:
- Retrospective review of provincially-insured patients undergoing ULMD stenting (2000-2011).
- SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS Drug-Eluting Stent and Cardiac Surgery) scores calculated to assess coronary disease extent.
- In-hospital and long-term death and Major Adverse Cardiac Event (MACE) rates analyzed via health claims data linkage.
Main Results:
- 221 patients underwent ULMD stenting.
- In-hospital death: 13.1%; MACE: 15.4%.
- At 3.1 years follow-up, 49.3% died and 68.3% experienced a MACE. Higher SYNTAX tertile and bare-metal stents were linked to increased mortality.
Conclusions:
- This study represents the largest Canadian cohort of ULMD stenting over a decade.
- Coronary stenting demonstrated acceptable in-hospital events but poor long-term outcomes.
- Results reflect the high-risk nature of patients selected for this procedure.
Background:
Coronary stenting is increasingly used to treat unprotected left main disease in selected patients. However, there is a paucity of data on the long-term outcome of these patients in a Canadian context outside of clinical trials.
Methods:
We retrospectively reviewed all provincially-insured patients undergoing left main coronary stenting at a large tertiary referral centre from 2000-2011. Pre-procedural angiograms were reviewed to identify the location of left main disease, and extent of concomitant coronary disease quantified by calculating Synergy Between Percutaneous Coronary Intervention With TAXUS Drug-Eluting Stent and Cardiac Surgery (SYNTAX) scores for each patient. In-hospital death and major adverse cardiac event (MACE) rates were evaluated as were long-term death and MACE rates obtained via linkage of our institutional registry with the Ontario health claims database.
Results:
Two hundred twenty-one patients underwent unprotected left main stenting with 29 (13.1%) in-hospital death and 34 (15.4%) a MACE. At an average follow-up of 3.1 ± 2.8 years, 109 patients (49.3%) died and 151 (68.3%) experienced a MACE. Higher SYNTAX tertile and use of bare metal rather than drug-eluting stents was associated with increased rates of in-hospital and long-term death.
Conclusions:
This study reports, to our knowledge, the largest Canadian cohort of unprotected left main stenting over more than a decade. Coronary stenting was associated with acceptable in-hospital event rates, but poor long-term outcomes, reflecting the higher-risk population traditionally selected for this procedure.
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