Long-term outcomes of elective drug-eluting stenting of the unprotected left main coronary artery in patients with normal left ventricular function.

Objectives: To evaluate the early and long-term outcomes of patients with normal left ventricular function who undergo elective unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with drug-eluting stents (DES).

Background: Although the standard of care for patients with ULMCA disease is coronary artery bypass surgery, the current guidelines recommend PCI in clinical conditions that predict an increased risk of adverse surgical outcomes. The long-term outcomes of patients with low risk of adverse surgical outcomes who undergo PCI are unknown.

Methods: Data from a multicenter international registry, which included 221 consecutive patients from four institutions with normal left ventricular function who underwent elective ULMCA PCI with DES from 2002 to 2009, were collected.

Results: There was no cardiac death, Q-wave myocardial infarction, target lesion revascularization (TLR), stent thrombosis, or stroke within the first 30 days. Seven (3%) patients had periprocedural myocardial infarction. Follow-up angiography was performed in 136 (62%) patients. Kaplan-Meier event-free survival curves at 1 year for cardiac death and TLR rates were 97.7% ± 1.0% and 92.9% ± 1.8%, respectively. At the mean follow-up of 44.8 ± 22.8 months, the event-free rates for cardiac death and TLR were 95.5% ± 1.5% and 88.9% ± 2.3%, respectively. Multivariate analyses identified the predictors of cardiac death: age ≥ 75 years (P = 0.015) and history of myocardial infarction (P = 0.017).

Conclusions: Elective ULMCA PCI with DES in patients with normal left ventricular function is safe and effective with excellent short-term outcomes and favorable long-term outcomes and may be a viable option for low-risk patients with normal left ventricular function.