Three-Year Outcomes Post Percutaneous Coronary Intervention for Left Main Coronary Artery Disease

Abstract

Introduction: To identify the safety and long-term outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents for unprotected left main coronary artery disease (ULMCAD) and to compare outcomes between provisional single-stent and double-stent techniques.

Methods: In this observational study, patients diagnosed with ULMCAD who underwent PCI were enrolled. Clinical data, angiographic characteristics, and outcomes at 1 and 3 years-including cardiac admission, cardiac death, target lesion revascularization (TLR), and major adverse cardiac and cerebrovascular events (MACCE)-were collected and analyzed at Al-Najaf Cardiac Center.

Results: Between January 2014 and January 2017, 500 patients were included in the study. Mean (SD) age was 65 (11) years, 364 patients (72.8%) were male, and hypertension was the most common risk factor, occurring in 353 patients (70.5%). Distal left main lesions were predominant, occurring in 425 patients (84.9%), and the double-stenting technique was used in 356 cases (71.3%). Procedural success was 100%, with no in-hospital mortality or major complications. At 1-year follow-up, cardiac death was recorded in 4 patients (0.8%), TLR in 8 patients (1.6%), and MACCE in 16 patients (3.1%). At 3-year follow-up, cardiac death increased to 8 patients (1.6%), TLR to 20 patients (4.4%), and MACCE to 41 patients (8.2%). Patients treated with a provisional single stent had significantly lower rates of cardiac hospital admission and MACCE compared with double stenting (1 [0.7%] vs 32 [9%]; P=.0403 and 3 [2.1%] vs 70 [20%]; P=.0054, respectively).

Conclusion: PCI with drug-eluting stents for ULMCAD was safe and effective, with favorable long-term outcomes in patients who were unfit for surgery or refused surgery. The provisional single-stent technique demonstrated better clinical outcomes than the double-stent approach.