Drug‐eluting stent supported percutaneous coronary intervention for unprotected left main disease

Abstract

Objectives: This study sought to determine the clinical and angiographic outcomes of unselected patients receiving drug‐eluting stents for unprotected left main disease. Background: The results of several series of percutaneous coronary intervention (PCI) for left main disease in the pre‐drug‐eluting stent era have arisen concerns on the safety and mid‐term efficacy of PCI. Methods: Consecutive patients with unprotected left main disease were considered eligible for drug‐eluting stent supported PCI. The surgical risk score (risk of death within 1 month) of each patient was calculated according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) model. Results: One‐hundred and one patients with unprotected left main disease underwent PCI. The mean EuroSCORE was 19 ± 23. Successfully left main stenting was performed in 98 patients (primary success rate 97%). The overall 1‐month mortality rate was 9.9%. The 1‐month mortality rate was 50% in patients with acute myocardial infarction (AMI) on presentation, and 4.5% in patients without AMI on presentation. The 1‐month mortality rate of patients with a risk score <13 was 3%, while it was 21% in patients with a risk score ≥13. At 6 months, the mortality rate of the entire cohort of patients increased to 12.8%, and the one of the non‐AMI patients to 7.8%. Survival rate was 86% ± 4% (mean follow‐up 295 ± 175 days). Target vessel revascularization was performed in 14 patients (16%). The 6‐month in‐segment restenosis rate was 16%. Conclusion: Drug‐eluting stent supported PCI may provide early and mid‐term outcomes comparable or superior to those expected from coronary artery surgery.