Long-Term Results of Left Main Coronary Artery Percutaneous Coronary Interventions with Second Generation Drug-eluting Stent Implantation in Stable Coronary Artery Disease

Victor S. Grigoryev ¹, Leo A. Bockeria ¹, Karen V. Petrosyan ¹, Andrey V. Abrosimov ¹, Bagrat G. Alekyan ², Olga L. Bockeria ¹, Yuriy I. Buzhiashvili ¹, Elena Z. Golukhova ¹, Tatyana G. Nikitina ¹, Vladislav A. Poluboyarinov ¹

¹ Bakoulev Center for Cardiovascular Surgery, Moscow, Russia; ² A.V. Vishnevsky Institute of Surgery, Moscow, Russia;

Date, time and location: 2018.05.26 15:30, Congress Hall, 2F–A

Abstract

Methods:In our Center from 2013 to 2016 LMCA PCI with second generation DES implantation in stable course of CAD were performed in 133 patients aged from 42 to 88 (mean 66.3±10.3) years. There were 98 (73,7%) males and 35 (26,3%) females. Comorbidity included LVEF < 45% (12,8%), PAD (45,9%), DM (32,3%), oncology history (2,3%). LMCA was 104 «unprotected» in (78,2%) cases of and «protected» in 29 (21,8%) cases. Time since CABG was at mean 6,5±3,1 years. Approximately a third (27,6%) of patients with «protected» and more than a third (38,5%) of patients with «unprotected» LMCA disease had a history of non-LMCA PCI from 1 to 17 (mean 3,8± 3,8) years. One-step or staged non-LMCA PCI was performed inв 32 (30.8%) and 11 (37.9%) cases for «unprotected» and «protected» cohorts, respectively. One-stent technique was performed in 99 (74,5%) patients, thus two-stent approach was performed in 34 (25,5%) cases using T-stenting (70,6%), V-stenting (2,9%) and culotte (26,5%) techniques.

Results:Technical success was 99,2 % without in-hospital mortality. Long-term evaluation was performed in 85,7% of patients up to 3 years. Long-term MACCE rate was 20,3% with 94% survival rate. Repeat revascularization took place in 20 (15%) patients with 2 (10%) CABG cases, nevertheless in 15 (75%) patients for non-LMCA failure. Difference between «unprotected» and «protected» cohorts in regard to MACCE rate (р=0.15) as repeat revascularization rate (р=0,20) was not significant. The only strong predictor of adverse events was combination of age > 65 years (р=0.01) and DM (р=0.003).

Conclusions:PCI is safe and effective treatment option for different types of LMCA disease with low long-term risk of adverse events. Difference in adverse events rate between «unprotected» and «protected» cohorts, SYNTAX score struts wasn’t significant in our study, that allow to suspect comparable PCI efficacy in the overall cohort of LMCA disease patients.