Long-Term Clinical Outcomes of Unprotected Left Main Percutaneous Coronary Intervention: A Large Single-Centre Experience

Abstract

Aims: This study sought to report the 10-year clinical outcomes of patients who underwent unprotected left main (LM) percutaneous coronary intervention (PCI) in a large centre.

Methods and results: A total of 913 consecutive patients who underwent unprotected LM PCI from January 2004 to December 2008 at Fu Wai Hospital were retrospectively analysed; the mean age was 60.0 ± 10.9 years, females accounted for 22% of patients, diabetes was present in 27.7% of patients, and an LM bifurcation lesion occurred in 82.9% of patients. During the median follow-up of 9.7 years, major adverse cardiac or cerebrovascular events (MACCEs) occurred in 25.6% (234) of patients, and the rates of all-cause death, myocardial infarction, and stroke were 14.9%, 11.0%, and 7.1%, respectively. Cardiac death occurred in only 7.9% of patients. The estimated event rate was 41.9% for death/myocardial infarction/any revascularization and 45.9% for death/MI/stroke/any revascularization. Definite/probable stent thrombosis occurred in 4.3% (39) of patients. According to the subgroup analysis, IVUS-guided PCI was associated with less long-term MACCEs. Further multivariate analysis identified that age and LVEF<40% were the only independent predictors for 10-year death. Age, LVEF<40%, creatinine clearance, and incomplete revascularization were independent predictors for death/MI, while a two-stent strategy, diabetes, a transradial approach, and the use of bare metal stents (BMSs) or first-generation drug-eluting stents (DESs) were not.

Conclusions: Unprotected LM PCI in a large cohort of consecutive patients in a single large centre demonstrated favourable long-term outcomes up to 10 years even with the use of BMSs and first-generation of DESs.

Figure 1

Patient flow. PCI = percutaneous coronary intervention; LM = left main.

Figure 2

Long-term efficiency and safety after LM PCI. (a) Kaplan–Meier curves for death, cardiac death, MI, and stroke events; (b) Kaplan–Meier curves for composite events including death/MI and death/MI/stroke. MI = myocardial infarction.

Figure 3

10-year target lesion revascularization and target-vessel revascularization. Annual target lesion revascularization (a) and target-vessel revascularization (b) event rates.

Figure 4

Survival curves of 10-year death/MI/stroke events among subgroups. The surgical exclusion population included patients meeting any one of the following criteria: chronic obstructive pulmonary disease, left ventricular ejection fraction <35%, age >70, acute myocardial infarction with haemodynamic instability, creatinine clearance <50, or bleeding history within 6 months. BMS = bare metal stent; DES = drug-eluting stent; and IVUS = intravascular ultrasound. Other abbreviations are as in Figure 2.