Abstract 13571: Progression of Left Main Coronary Artery Disease Following Left Sided Branch Vessel Percutaneous Coronary Intervention
Objectives: Little is known about the incidence and progression of left main coronary artery stenosis (LMCAS) following left sided PCI for branch vessel coronary artery disease. This study examined the demographic and procedural characteristics of patients with rapid progression of nonsignificant LMCAS following PCI for left sided lesions.
Methods: Patients undergoing CABG for significant LMCAS who previously underwent at least 1 PCI (intravascular ultrasound, angioplasty, cutting balloon, atherectomy, stent) for left sided branch vessel disease were evaluated for progression of LMCAS at one institution. Patients were categorized as fast or slow progression of stenosis using progression velocity (percent change in LMCAS from the first PCI to CABG divided by time interval in months). Demographic data, medications, and intervention details were included. Outcomes and Kaplan Meier survival were compared.
Results: Between September 1997 and November 2010, 4945 patients underwent isolated CABG and 118 underwent CABG for LMCAS and had at least 1 previous left sided PCI. There were 59 slow progression patients and 59 fast progression. Follow up was 4.9 yrs + 3.6 and 6.9 yrs + 3.9, respectively. Fast progression patients had a shorter time from PCI until CABG (2.5 yrs vs 10.6 yrs, p<0.001), were younger (p= 0.042) and had a trend towards less renal failure (p=0.061) and less dyslipidemia (p=0.057). They also had higher LM baseline stenosis at first PCI (16.4% vs 9%, p=0.025). There were no differences in the number of PCI, number of vessels addressed at PCI, or vessel type addressed at PCI (Table). There were no differences in Kaplan Meier survival at 1, 3, or 5 yrs.
Conclusions: PCI exposes the LM to repeated endothelial damage from catheter manipulation. This may lead to increased speed of progression of nonsignificant LM disease. The shorter time interval (2.5 yrs) from first PCI to CABG in fast progression patients suggests the need for further investigation.
- © 2012 by American Heart Association, Inc.