Acute and long term results of unprotected left main stenting using drug eluting stents.

BACKGROUND

Most available data indicates that stenting for unprotected left main coronary artery disease (ULMCA) with drug-eluting stents (DES) is safe and effective. At present, surgery is considered the gold standard for optimal revascularization. The aim of this study was to evaluate the immediate and long term outcome of patients with ULMCA stenosis who underwent percutaneous coronary intervention (PCI) with DES implantation in a single center.

METHODS

Coronary stents were implanted into ULMCA in 72 patients. Patients with a de novo ≥ 50% diameter stenosis, or ≤ 4.0 mm(2) on intravascular ultrasound measurement of left main coronary artery were treated using 1.6 ± 1.2 DES per patient. ULM stenting was performed when coronary artery bypass grafting was considered at high surgical risk (mean EuroSCORE 7.1) and/or surgery was refused despite their physician's recommendation. Patients enrolled in the study underwent clinical evaluation one, six and 12 months after the procedure, and then annually. Coronary angiography was routinely performed at nine to 12 months from the index procedure and/or was clinically driven at any time. Acute and long term main adverse cardiac events (MACE) were assessed: cardiac death, myocardial infarction and additional target lesion or non-target lesion revascularization (TLR).

RESULTS

Angiographic and clinical success of PCI was 100%. Complete revascularization was performed in all patients. Mean follow-up duration was 2.5 years ± 10 months with 3% mortality in the first 12 months and total MACEs in 30.6%. During follow-up, death occurred in four (5.5%) patients. Angiographic follow-up was performed in 59 (82%) patients and TLR occurred in 18.05% of treated lesions. One possible stent thrombosis was documented.

CONCLUSIONS

Considering the high surgical risk present in most of our patients, ULM stenting is feasible and safe with excellent immediate and mid-term results. Long term results seem to be encouraging, showing limited mortality and the total absence of definite or probable thrombosis.