title: Long-term outcomes of elective drug-eluting stenting of the unprotected left main coronary artery in patients with normal left ventricular function.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Cardiology, UCLA Medical Center, Los Angeles, California 90095-171715, USA. mslee@mednet.ucla.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: Tae
authors.initials: T
authors.lastname: Yang
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Dario
authors.initials: D
authors.lastname: Sillano
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Jola
authors.initials: J
authors.lastname: Xhaxho
authors.forename: Joseph
authors.initials: J
authors.lastname: Aragon
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002140:California; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D018579:Patient Selection; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left