title: Percutaneous coronary intervention of unprotected left main disease: five-year outcome of a single-center registry.
abstract: OBJECTIVE
  Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main coronary artery (ULMCA) lesions. We aimed to evaluate the long-term outcome of patients undergoing ULMCA PCI.
  
  
  RESULTS
  We retrospectively analyzed 95 consecutive patients (median EuroSCORE I 2.9 [IQR 1.4;6.1]) who underwent ULMCA PCI between 1999 and 2006, included in a single-center prospective registry. The primary outcome was major adverse cardiovascular events (MACE) defined as all-cause death, myocardial infarction (MI) and target lesion revascularization (TLR) at five years. Forty patients (42.1%) were treated in the setting of acute coronary syndrome and 81 patients (85%) had at least one additional significant lesion (SYNTAX score 24.2±11.8). Single ULMCA PCI was performed in 33% (81.1% with drug-eluting stents) and complete functional revascularization was achieved in 79% of the patients. During the observation period, 20 patients died (21.1%), 6 (6.3%) had MI and 11 (11.6%) had TLR (total combined MACE 28.4%). Independent predictors of MACE were previous MI (HR 2.9 95% CI 1.23-6.92; p=0.015), hypertension (HR 5.7 95% CI 1.86-17.47; p=0.002) and the EuroSCORE I (HR 1.1 95% CI 1.03-1.12; p=0.001). Drug-eluting stent implantation was associated with a significantly lower MACE rate, even after propensity score adjustment (AUC=0.84; HR [corrected] 0.1; 95% CI 0.04-0.26; p<0.001).
  
  
  CONCLUSIONS
  Unprotected left main percutaneous coronary intervention, particularly using drug-eluting stents, can be considered a valid alternative to coronary artery bypass grafting, especially in high-risk surgical patients and with favorable anatomic features.
authors.affiliation: Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal. Electronic address: heldores@hotmail.com.
authors.forename: Hélder
authors.initials: H
authors.lastname: Dores
authors.affiliation: Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Raposo
authors.affiliation: Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Manuel Sousa
authors.initials: MS
authors.lastname: Almeida
authors.affiliation: Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Brito
authors.affiliation: Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Pedro Galvão
authors.initials: PG
authors.lastname: Santos
authors.affiliation: Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Pedro Jerónimo
authors.initials: PJ
authors.lastname: Sousa
authors.affiliation: Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Henrique Mesquita
authors.initials: HM
authors.lastname: Gabriel
authors.affiliation: Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Pedro Araújo
authors.initials: PA
authors.lastname: Gonçalves
authors.affiliation: Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Rui Campante
authors.initials: RC
authors.lastname: Teles
authors.affiliation: Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Francisco Pereira
authors.initials: FP
authors.lastname: Machado
authors.affiliation: Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Drug-eluting stents; Intervenção coronária percutânea; Percutaneous coronary intervention; Stents revestidos por fármaco; Tronco comum não protegido; Unprotected left main