Long-term outcome of percutaneous coronary intervention for unprotected left main coronary artery disease

Objectives: The aim of this study is to evaluate the in-hospital, 30 day and long-term outcomes after percutaneous coronary intervention for unprotected left main coronary artery disease. Backgrounds: Left main coronary artery (LMCA) diseases stenosis is a strong indication for coronary artery bypass grafting (CABG). With improved device technology, percutaneous coronary intervention (PCI) with drug-eluting stent (DES) stents had been recently advocated as an alternative procedure for the unprotected LMCA disease. Methods: Between January 2003 and February 2007, all unprotected LMCA PCI procedures were retrospectively collected. Outcomes were obtained by chart record review and telephone interview. Results: Fifty five consecutive patients with >50% diameter stenosis of LMCA undergoing PCI were analyzed. Indications for a percutaneous strategy were prohibitive surgical risks, or patient/physician preference. The procedural success rate was 98%. 41 patients (75%) received DES implantation. The majority of cases (n=33) were treated with a double-stent strategy. There were no in-hospital deaths. The clinical follow-up time was 867+/-410 days (range 20-1715). 18 (29%) patients experienced major adverse cardiac events, including 3 (5%) deaths, 4 (7%) myocardial infarctions, and 12 (21.8%) target lesion revascularizations (TLR) during follow-up. Multivariate analysis revealed hyperlipidemia (Hazard ratio, HR=6.2, p=0.024) and bifurcation involvement (HR=4.4, p=0.008) were independent predictors for MACE. Conclusions: Our results showed that PCI with stenting was an acceptable treatment option for patients with LMCA stenosis. Involvement of the LMCA bifurcation remains a predictor for unfavorable outcome. (C) 2008 Elsevier Ireland Ltd. All rights reserved.