title: Long-term outcome of unprotected left main stenting: a Canadian tertiary care experience.
abstract: BACKGROUND
  Coronary stenting is increasingly used to treat unprotected left main disease in selected patients. However, there is a paucity of data on the long-term outcome of these patients in a Canadian context outside of clinical trials.
  
  
  METHODS
  We retrospectively reviewed all provincially-insured patients undergoing left main coronary stenting at a large tertiary referral centre from 2000-2011. Pre-procedural angiograms were reviewed to identify the location of left main disease, and extent of concomitant coronary disease quantified by calculating Synergy Between Percutaneous Coronary Intervention With TAXUS Drug-Eluting Stent and Cardiac Surgery (SYNTAX) scores for each patient. In-hospital death and major adverse cardiac event (MACE) rates were evaluated as were long-term death and MACE rates obtained via linkage of our institutional registry with the Ontario health claims database.
  
  
  RESULTS
  Two hundred twenty-one patients underwent unprotected left main stenting with 29 (13.1%) in-hospital death and 34 (15.4%) a MACE. At an average follow-up of 3.1 ± 2.8 years, 109 patients (49.3%) died and 151 (68.3%) experienced a MACE. Higher SYNTAX tertile and use of bare metal rather than drug-eluting stents was associated with increased rates of in-hospital and long-term death.
  
  
  CONCLUSIONS
  This study reports, to our knowledge, the largest Canadian cohort of unprotected left main stenting over more than a decade. Coronary stenting was associated with acceptable in-hospital event rates, but poor long-term outcomes, reflecting the higher-risk population traditionally selected for this procedure.
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sibbald
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Chan
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Daly
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Horlick
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Douglas
authors.initials: D
authors.lastname: Ing
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Ivanov
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Mackie
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Osten
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Overgaard
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. Electronic address: vlad.dzavik@uhn.ca.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D063128:Tertiary Health Care; D013997:Time Factors