Abstract 4347: Long-term Clinical Results Following Stenting of the Left Main Stem: Insights From RESEARCH and T-SEARCH Registries
Objectives: There is limited information on long-term (>3 year) outcomes after DES implantation for unprotected left main coronary artery disease (ULMCA). Furthermore, bifurcation angle and Syntax score are emerging as parameters for patient risk stratification and their prognostic implications have still to be elucidated. We investigated the 4-year clinical outcomes and independent predictors of major cardiac events in ULMCA patients treated by percutaneous coronary intervention (PCI) with drug-eluting stent (DES).
Methods: One hundred and forty-eight patients with ULMCA treated with DES were analyzed and compared to an historical cohort of 79 patients who received BMS for the treatment of ULMCA stenosis. Syntax Score was calculated by dedicated software while pretreatment bifurcation angle was assessed by quantitative coronary angiography. Patient-oriented composite endpoint was defined as the occurrence of all-cause death, any myocardial infarction or any revascularization.
Results: Clinical follow-up was available in all patients, with a median duration of follow-up of 1473 days. The 4-year cumulative incidence of all-cause death, any myocardial infarction, any revascularization and patient-oriented composite were 35.6%, 3.8%, 25.2% and 54.4%, respectively. From one to four years, these endpoints showed a relative increase of 70%, 5%, 50% and 68%, respectively. When compared to a historical cohort who received BMS for ULMCA treatment, landmark analysis of the last two years of follow-up demonstrated that the DES cohort had significantly higher patient-oriented composite endpoint(26% vs. 8%, p=0.02). EuroScore, cardiogenic shock at entry and Syntax score were identified as independent predictors for the 4-year patient-oriented composite endpoint, while bifurcation angle was not.
Conclusions: Late increase in patient-oriented composite endpoints after DES implantation for ULMCA warrants careful and long-term follow-up. Syntax score and EuroScore appear to have a significant prognostic value in long-term patient risk.