Favorable Long-Term Outcomes for Unprotected Left Main PCI

Long-term outcomes of unprotected left main (LM) percutaneous coronary intervention (PCI) were found to be favorable, according to a study published in the Journal of Interventional Cardiology.

In this retrospective study, the data of 913 consecutive patients (mean age, 60.0±10.9 years) who underwent unprotected LM PCI between 2004 and 2008 at a single center in China were examined. In this cohort, 82.9% of patients had an LM bifurcation lesion, 11.4% had an LM ostium lesion, and 5.7% had an LM shaft lesion.

The study’s primary efficacy endpoint was target-vessel revascularization (TVR), and the primary safety endpoint, a composite of death, myocardial infarction (MI), and stroke.

During a median follow-up of 9.7 years, 25.6% of patients (95% CI, 22.7–28.5%) experienced a major adverse cardiac or cerebrovascular event. The 10-year estimated rates of all-cause death, MI, and stroke were 14.9% (95% CI, 12.5–17.3%), 11.0% (95% CI, 8.9–13.0%), and 7.1% (95% CI, 5.4–8.8%), respectively. Cardiac death occurred in 7.9% of patients (95% CI, 6.1–9.7%).

The estimated event rates for the composites of death/MI/any revascularization and death/MI/stroke/any revascularization were 41.9% and 45.9%, respectively, and 4.3% of patients (95% CI, 2.9–5.6%) experienced definite/probable stent thrombosis during the follow-up period.

In a subgroup analysis, intravascular ultrasound- vs angiography-guided LM PCI was associated with a significant reduction in long-term death/MI/stroke (20.8% vs 27.7%, respectively; P =.03). In addition, the 10-year rate of death/MI/stroke was higher in patients not selected vs selected for surgery because of the presence of comorbidities or surgical ineligibility and in patients in whom bare metal vs first-generation drug-eluting stents were used (32.7% vs 23.9%, respectively; P <.04).

Factors that were found to independently predict 10-year death were age (hazard ratio [HR], 1.71; 95% CI, 1.37-2.12; P <.001) and left ventricular ejection fraction (LVEF) <40% (HR, 4.51; 95% CI, 1.98-10.28; P <.001). Additionally, independent predictors of death/MI included age (HR, 1.15; 95% CI, 1.07-1.24; P <.001), LVEF <40% (HR, 1.89; 95% CI, 1.09-3.28; P =.02), creatinine clearance (HR, 1.04; 95% CI, 1.02-1.06; P =.001), and incomplete revascularization (HR, 1.16; 95% CI, 1.01-1.33; P =.03).

Limitations of this study include its observational and retrospective design as well as exclusion of patients who underwent LM coronary artery bypass grafting (CABG).

“Further study should focus on the long-term outcomes of LM PCI in comparison with LM-CABG to provide more evidence,” concluded the study authors.

Reference

Gao L, Gao Z, Song Y, et al. Long-term clinical outcomes of unprotected left main percutaneous coronary intervention: A large single-centre experience. J Interv Cardiol. Published online January 12, 2021. doi:10.1155/2021/8829686