Abstract 2641: One-Year Outcome of the Left Main TAXUS Pilot Study
Background: CABG is the gold standard treatment of unprotected left main (LM) stenosis. Percutaneous coronary intervention (PCI) has been proposed as an alternative treatment in some centers with excellent in-hospital results, but few data are available on long-term outcome in the real world.
Methods: A pilot feasibility and safety study using the TAXUS stent was set up in 4 French centers with wide experience in LM stenting. PCI was proposed as an alternative to CABG in patients (Pts) with de novo unprotected LM stenosis. The main technical recommendations were to systematically cover the LM ostium with the stent and use a provisional T stenting approach in cases of distal LM lesion with systematic final kissing balloon inflation (Kiss). Acute MI and cardiogenic shock were the only exclusion criteria. A very strict clinical follow-up was set up with a recommended angiogram at 6 to 8 months.
Results : Between May 2003 and June 2005, 291 Pts were included (Age 69±11 years, diabetes 29, previous MI 12%, 3 vessel disease 26%, distal LM 78%, additive Euroscore 4.8±3.4 and logistic Euroscore 6.6±10.8). In Pts with distal LM lesion a second stent (T stenting in 99.5%) was used in 41% of cases and Kiss in 97%. Angiographic success was obtained in 99.5% (1 procedural stent thombosis) and in-hospital MACCE rate was 3.4% (death 0.7%, non-Q-wave MI 2.7% and emergency CABG 0.3%). Clinical follow-up was obtained at 8 –12 months in 98% of cases. Total MACCE rate was 11.3% (Cardiac death 2.3%, including 3 sudden deaths: 0.9%, non cardiac death 1.4%, Q-wave MI 0%, non-Q-wave MI 3.4%, stroke 0.5% and TVR 5.6%). Coronary angiogram was performed in 178 Pts (64%) at 6.9±2.6 months. Seventeen patients had LM restenosis, 4 at the ostium which was unstented, 6 in the proximal Circ (stented 4 and unstented 2), 5 in LM stent, 1 in the distal LM (unstented) and 1 in the LAD (stented).
Conclusion: PCI of unprotected LM PCI using the TAXUS stent was associated with excellent angiographic results and in-hospital outcomes. Mid-term follow-up is very promising. A complete 1 year follow-up will be presented at the meeting.