title: Clinical outcomes of "complete, partially complete, and incomplete" revascularisation at five-year follow-up after percutaneous intervention of unprotected left main coronary artery disease with drug-eluting stents.
abstract: OBJECTIVE
  The study aimed to examine five-year clinical outcomes of complete (CR), partially complete (PCR), and incomplete revascularisation (ICR) in patients with unprotected left main coronary artery (ULMCA) disease treated with drug-eluting stents (DES). Completeness of revascularisation, defined as revascularisation of all vessels ≥1.5 or 2.5 mm in diameter, has been shown to correlate with outcomes after percutaneous coronary intervention (PCI). There are no data to compare revascularisation strategies on long-term clinical outcomes in patients undergoing PCI of ULMCA disease.
  
  
  RESULTS
  This prospective registry enrolled 910 consecutive patients with ULMCA disease undergoing PCI with DES implantation. CR included patients who had a successful revascularisation of all diseased segments with diameter ≥1.5 mm. PCR included patients who had successful revascularisation of all diseased segments with diameter ≥2.5 mm. ICR included patients who did not achieve revascularisation for all diseased segments of diameter ≥2.5 mm. The primary endpoint was the incidence of major adverse cardiac events (MACE: a composite of cardiac death, myocardial infarction and repeat revascularisation) at five-year follow-up. CR was achieved in 386 (42.4%), PCR in 227 (25.0%), and ICR in 297 (32.6%) patients. Patients with ICR had a significantly higher rate of MACE (29.6% vs. 22.5% and 15.5%, p<0.001) and all-cause mortality (12.5% vs. 7.0% and 6.2%; p=0.006) than those with CR and PCR at five-year follow-up. After propensity score matching, patients with CR vs. PCR had similar incidences of MACE (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 0.78-1.74, p=0.46), mortality (HR: 1.27, 95% CI: 0.61-2.63, p=0.53), and cardiac death (1.8% vs. 4.5%; HR: 2.56, 95% CI: 0.80-8.17, p=0.11). On multivariable logistic regression analysis, ICR appears to be an outcome of poor clinical characteristics, comorbidities and complex coronary anatomy.
  
  
  CONCLUSIONS
  In the treatment of patients with ULMCA disease, ICR was associated with worse long-term clinical outcomes than CR and PCR. PCR has clinical outcomes similar to CR in patients with ULMCA disease treated with DES.
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Javaid
authors.initials: J
authors.lastname: Iqbal
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Christos V
authors.initials: CV
authors.lastname: Bourantas
authors.forename: Dao-Rong
authors.initials: DR
authors.lastname: Pan
authors.forename: Nai-Liang
authors.initials: NL
authors.lastname: Tian
authors.forename: Jing
authors.initials: J
authors.lastname: Kan
authors.forename: Xue-Song
authors.initials: XS
authors.lastname: Qian
authors.forename: Shi-Qing
authors.initials: SQ
authors.lastname: Ding
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.forename: Ai-Ping
authors.initials: AP
authors.lastname: Zhang
authors.forename: Yue-Qiang
authors.initials: YQ
authors.lastname: Liu
authors.forename: Takashi
authors.initials: T
authors.lastname: Muramatsu
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D003324:Coronary Artery Disease / Q000601:surgery*; D003920:Diabetes Mellitus / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome