Abstract 14845: Outcomes of Unprotected Left Main Coronary Artery Percutaneous Intervention as Compared to Multivessel Interventions.
Percutaneous coronary intervention (PCI) has emerged as an attractive alternative to bypass surgery for significant unprotected left main coronary artery (LMCA) disease, especially in high-risk candidates. PCI for unprotected LMCA stenosis is currently designated as a Class IIb indication. Direct comparisons between unprotected LMCA PCI and multivessel PCI are lacking. We aimed to calculate the short term and long term incremental risk associated with LMCA-PCI in comparison to multivessel PCI.
Methods: Cleveland Clinic PCI database was queried to identify patients who underwent unprotected LMCA-PCI between 2003–2009. These were compared with patients undergoing multi-vessel PCI (2-vessel and 3-vessel) in the same time period. Patients undergoing PCI for acute myocardial infarction were excluded. Mortality was derived using Social Security Death Index.
Results: Short-term (<30 days) mortality rates in LMCA-PCI group (2.2% n=475) were similar to death rate in both 3-vessel PCI (0.5%, p=0.1; n=184) as well as in 2-vessel PCI groups (1.3%, p=0.1; n=1798). Although the unadjusted long-term mortality was significantly higher in the LMCA-PCI group, the adjusted estimates did not reveal any significant difference in long-term mortality between the LMCA-PCI group and the multivessel PCI groups. A significantly higher adjusted long-term mortality was observed in the patients undergoing LMCA-PCI with bare metal stents as compared to those undergoing PCI with drug eluting stents. Stratifying the LMCA-PCI by number of concomitant vessel territories treated; there was no significant difference in mortality in any of the LMCA-PCI categories (LMCA only, LMCA + 1-vessel, LMCA + 2-vessel, LMCA + 3-vessel) in comparison to multivessel PCI (Figure 1).
Conclusions: We observed a comparable short-term mortality and adjusted long-term mortality in the LMCA-PCI group and the MVD-PCI groups. LMCA stenting does not seem to incur incremental risk compared to MVD-PCI.
- © 2010 by American Heart Association, Inc.