Long-term follow-up of percutaneous coronary intervention of unprotected left main lesions with drug eluting stents: predictors of clinical outcome

Aims: To evaluate the long-term follow-up of drug-eluting stents (DES) in the treatment of unprotected left main coronary artery (ULMCA). Methods and results: One hundred and forty-eight patients (mean age 71 +/- 10 years) with ULMCA stenoses underwent percutaneous coronary intervention (PCI) with DES. Mean ejection fraction (EF) was 63 +/- 13% and distal ULMCA was involved in 63.5% of cases. In-hospital outcome showed one intra-procedural death, no stent thrombosis and 2% non Q-wave myocardial infarction (MI). Clinical follow-up was available in all patients (874 +/- 382 days): 10.1% of them had died, 8.8% had target lesion revascularisation (TLR) and 4.1% experienced MI. Major adverse cardiac events (MACE) occurred in 20.3%. Mortality predictors were EF <= 55% (OR 3.6, 95%-CI. 1.3-10.1, p=0.016) and EuroSCORE >= 6 (OR 3.9, 95%-CI 1.1-14.1, p=0.037). TLR predictors were distal lesion (OR 8.5, 95%-CI 1.1-15, p=0.041) and age<64 years (OR 3.1, 95%-CI 1-9, p=0.042). MACE predictor was EF <= 55% (OR 2.4, 95%-CI 1.1-5.2, p=0.027). Conclusions: ULMCA stenting with DES is safe, with favourable in-hospital outcome. Long-term results are acceptable with a mortality rate of 10%, a TLR rate of 9%, and a MACE rate of 20%. Low EF and high EuroSCORE predict mortality, while younger age and distal lesions predict TLR. Low EF also predicts MACE.