Abstract 17134: The Impact of Stent Diameter on Late Clinical Outcome in 734 Patients Treated by Percutaneous Coronary Intervention with Drug-Eluting Stent for Unprotected Left Main Coronary Artery Disease
Objectives To evaluate whether stent diameter has long-term prognostic implications in patients undergoing drug-eluting stent (DES) supported percutaneous coronary intervention (PCI) for Unprotected Left Main Coronary Artery (UPLMCA) disease.
Background There are no data on the long-term clinical impact of the stent diameter for patients undergoing PCI with DES implantation for UPLMCA disease.
Methods From April 2004 to December 2010, 734 consecutive patients with UPLMCA disease underwent DES implantation. A Major Adverse Cardiac or Cerebrovascular Event (MACCE) was defined as a composite of death, any myocardial infarction (MI), repeat revascularization or cerebrovascular event.
Results 465 patients (63%) were treated with a stent of diameter less than or equal to 3.5 mm and 269 patients (37%) with a stent of diameter greater than or equal to 4 mm. Patients treated with a smaller stent were older, smaller, and had a higher risk profile. More complex lesions and distal bifurcation were more often involved in these patients than in those treated with a bigger stent. After PCI, reference diameter by Quantitative Coronary Analysis (QCA) remained significantly smaller in patients treated with a stent of 3.5mm diameter or less compared to patients treated with a stent of 4 mm diameter or more (3.72±0.38mm vs. 4.32±0.36mm, p<0.0001). Total MACCE rate was 42.5% for patients with a smaller stent in the left main and 28.8% for patients with a bigger stent (p<0.0001). This difference was driven by an increase in both death and need for repeat revascularization. In multivariate analysis, the use of a stent diameter less than or equal to 3.5 mm was a predictor of MACCE (hazard ratio: 1.496, 95% confidence interval: 1.004 to 2.229; p=0.047).
Conclusions The use of a drug-eluting stent with a diameter less than or equal to 3.5 mm to treat LM disease is a significant predictor of long-term MACCE driven by a higher rate of death, restenosis and need for repeat revascularization.
- © 2012 by American Heart Association, Inc.