title: Long-Term (≥10 Years) Safety of Percutaneous Treatment of Unprotected Left Main Stenosis With Drug-Eluting Stents.
abstract: Percutaneous coronary intervention (PCI) of unprotected left main disease (ULM) with drug-eluting stents (DES) is hampered by lack of information on long-term (≥10 years) safety data. All patients treated with PCI on ULM in 9 international centers with at least 10 years follow-up were enrolled. Baseline and procedural features were recorded. Repeat PCI (re-PCI) on ULM at 10 years was the primary end point. Secondary end points included major adverse cardiac events and its components (cardiac and noncardiac death, myocardial infarction, re-PCI not on ULM, and stent thrombosis). Sensitivity analysis was performed according to the presence of isolated ULM disease: 284 patients were enrolled. A total of 70 patients (21%) performed a re-PCI on ULM, 39 in the first year, and 31 between 1 and 10 years (only 5 overall performed for acute coronary syndrome). Patients with re-PCI on ULM did not show differences in baseline and procedural features, or experience higher rates of cardiovascular death (12% vs 11%, p 0.65), myocardial infarction (11% vs 6%, p 0.56), or of re-PCI on non-ULM disease (31% vs 27%, p 0.76) compared with those without re-PCI on ULM. At Kaplan-Meier analysis, patients with PCI in other coronary vessels were at higher risk of major adverse cardiac events, driven by target vessel revascularization (20.4% vs 32.9%, p 0.009), as confirmed at multivariate analysis (stenosis other than LM; hazard ratio 2, 1.4 to 2.7, all CI 95%). In conclusion, despite of using first-generation stents, PCI on ULM is safe, with low rates of recurrent events due to index revascularization. Progression of atherosclerotic lesions on other coronary vessels represents the only independent predictive factor for prognosis.
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy; Division di Cardiologia, Ospedale Pederzoli, Verona, Italy.
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy. Electronic address: fabrizio.dascenzo@gmail.com.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Cardiology Department, Scientific Institute S. Raffaele, Milan, Italy.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy; Cardiology Department, Assiut University, Assiut, Egypt.
authors.forename: Salma
authors.initials: S
authors.lastname: Taha
authors.affiliation: Department of Cardiology, Institute Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Stephen O
authors.initials: SO
authors.lastname: Connor
authors.affiliation: Department of Cardiology, Sussex Cardiac Centre, Brighton, United Kingdom.
authors.forename: SujaySubash
authors.initials: S
authors.lastname: Chandran
authors.affiliation: Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: de la Torre Hernández
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Sl
authors.initials: S
authors.lastname: Chen
authors.affiliation: Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Varbella
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Iannaccone
authors.affiliation: Division of Cardiology, Ospedale Mauriziano, Turin, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Meliga
authors.affiliation: Cardiology Department, Scientific Institute S. Raffaele, Milan, Italy.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Kawamoto
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Montefusco
authors.affiliation: Department of Cardiology, Sussex Cardiac Centre, Brighton, United Kingdom.
authors.forename: Chong
authors.initials: C
authors.lastname: Mervyn
authors.affiliation: Department of Cardiology, Institute Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Sin
authors.affiliation: Division di Cardiologia, Ospedale Pederzoli, Verona, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Gasparetto
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdirashid
authors.affiliation: Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy; Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain.
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.affiliation: Division of Cardiology, La Sapienza, Rome, Italy; Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi Zoccai
authors.affiliation: Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.affiliation: Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.affiliation: Department of Cardiology, Sussex Cardiac Centre, Brighton, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hiddick Smith
authors.affiliation: Department of Cardiology, Institute Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.affiliation: Cardiology Department, Scientific Institute S. Raffaele, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome