Abstract 3657: Long Term Clinical and Angiographic Outcomes of Unprotected Left Main Coronary Artery Stenosis with Sirolimus-Eluting Stents
AIM Percutaneous treatment of Left Main Coronary Artery (LMCA) Disease is progressively becoming an alternative to surgery; recent studies showed excellent clinical results, both in short-term and in long-term follow-up periods, even though in selected poplulations. The aim of this study is to evaluate the safety and feasibility of SES implantation in a consecutive series of patients with left main coronary disease.
Methods: Between November 2002 and December 2004, a series of 85 consecutive patients (all comers ) with LMCA disease who underwent PCI with sirolimus eluting stent (Cypher) implantation was selected. According to Euroscore (evaluated in all ) 66% of patients were considered “high risk” or “very high risk” patients. The only exclusion criteria was a contraindication for antiplatelet or anticoagulation therapy. A total number of 118 stent were deployed (1,38 stent/patient), with a mean stent diameter of 3,21 ± 0,29 mm and a mean stent length of 14,1 ± 5,4 mm. Patients had an office visit after 30 – 40 days, followed by monthly telephone interviews and a final telephone interview or office visit at April 2005. Mean observation period was 595 ± 230 days. Angiographic follow-up was performed after 6–9 months or earlier if clinically driven.
Results: Intra-procedural death occurred in 1/85 patient, post-procedural AMI occurred in 3/85 patients. No patients had acute in-stent thrombosis, emergent CABG, stroke and cardiac arrest. At 9 months angiographic control Late Lumen Loss was 0,15 +- 0,81 mm and the overall Restenosis Rate was 8,2% (7/85). The MACE-free survival rate at 1 year and at the end of follow-up period was 88% and 73% respectively. We furthermore evaluated the incidence of adverse events in “high risk” subgroups of patients; none of them was significantly related with an increase of clinical or angiographic MACEs except for the sub-group treated with “extreme” post-dilation (final stent diameter >1mm than nominal stent size).
Conclusions: The use of SES for the treatment of unprotected left main lesions is safe with substained efficacy over time with a very low incidence of clinical and angiographic MACEs during the follow up despite the fact that this was an unselected polulation with many “high risk” patients.