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Percutaneous coronary intervention of unprotected left main disease: Five-year outcome of a single-center registry

2013; Elsevier BV; Volume: 32; Issue: 12 Linguagem: Inglês

10.1016/j.repc.2013.04.015

2174-2030

Hélder Dores, Luís Raposo, Manuel Almeida, João Brito, P Galvao Santos, Pedro Jerónimo Sousa, Henrique Mesquita Gabriel, Pedro de Araújo Gonçalves, Rui Campante Teles, Francisco Pereira Machado, Miguel Mendes,

Cardiac Imaging and Diagnostics

Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main coronary artery (ULMCA) lesions. We aimed to evaluate the long-term outcome of patients undergoing ULMCA PCI.We retrospectively analyzed 95 consecutive patients (median EuroSCORE I 2.9 [IQR 1.4;6.1]) who underwent ULMCA PCI between 1999 and 2006, included in a single-center prospective registry. The primary outcome was major adverse cardiovascular events (MACE) defined as all-cause death, myocardial infarction (MI) and target lesion revascularization (TLR) at five years. Forty patients (42.1%) were treated in the setting of acute coronary syndrome and 81 patients (85%) had at least one additional significant lesion (SYNTAX score 24.2±11.8). Single ULMCA PCI was performed in 33% (81.1% with drug-eluting stents) and complete functional revascularization was achieved in 79% of the patients. During the observation period, 20 patients died (21.1%), 6 (6.3%) had MI and 11 (11.6%) had TLR (total combined MACE 28.4%). Independent predictors of MACE were previous MI (HR 2.9 95% CI 1.23-6.92; p=0.015), hypertension (HR 5.7 95% CI 1.86-17.47; p=0.002) and the EuroSCORE I (HR 1.1 95% CI 1.03-1.12; p=0.001). Drug-eluting stent implantation was associated with a significantly lower MACE rate, even after propensity score adjustment (AUC=0.84; HR [corrected] 0.1; 95% CI 0.04-0.26; p<0.001).Unprotected left main percutaneous coronary intervention, particularly using drug-eluting stents, can be considered a valid alternative to coronary artery bypass grafting, especially in high-risk surgical patients and with favorable anatomic features.