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Impact of unprotected left main percutaneous coronary intervention on long-term clinical outcomes

a large single-center study

Xu, Lianjun*; Gao, Zhan*; Song, Ying; Wang, Huanhuan; Xu, Jingjing; Jiang, Ping; Jiang, Lin; Tang, Xiaofang; Chen, Jue; Gao, Lijian; Song, Lei; Zhang, Yin; Zhao, Xueyan; Qiao, Shubin; Yang, Yuejin; Gao, Runlin; Xu, Bo; Yuan, Jinqing

doi: 10.1097/MCA.0000000000000725
PCI
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Background With the advancements of percutaneous coronary interventions (PCI), it is not clear whether unprotected left main (ULM) coronary artery disease (CAD) remains an independent predictor of adverse outcomes after PCI therapy. We have therefore carried out a large cohort study to investigate the impact of ULM disease on 2-year clinical outcomes in Chinese patients undergoing contemporary PCI treatment.

Methods and results From January 2013 to December 2013, 10 724 consecutive patients undergoing PCI were prospectively collected. Two-year clinical outcomes were compared for patients undergoing ULM PCI and non-ULM PCI. Among the 10 724 patients, 272 (2.5%) patients underwent ULM PCI. Overall, these patients had higher baseline clinical risks of CAD and more extensive CAD compared with non-ULM PCI patients. During the 2-year follow-up, patients who underwent ULM PCI experienced higher incidence of cardiac death (2.2 vs. 0.7%; log-rank P=0.002), myocardial infarction (7.0 vs. 1.9%; log-rank P<0.001), stroke (2.9 vs. 1.3%; log-rank P=0.02), and definite and probable stent thrombosis (3.3 vs. 0.5%; log-rank P<0.001), than patients who underwent non-ULM PCI. However, the rates of revascularization (7.4 vs. 8.7%; log-rank P=0.48), target vessel revascularization (5.5 vs. 5.0%; log-rank P=0.66), and major adverse cardiac and cerebrovascular events (15.1 vs. 12.0%; log-rank P=0.11) were not significantly different between the groups. When performing adjusted Cox regression after propensity score matching, ULM PCI was not an independent risk factor of any clinical events (all P>0.05).

Conclusion In this large cohort of patients who underwent modern PCI, ULM PCI patients had higher baseline clinical risks and poorer prognosis during 2-year follow-up. However, after multivariate analysis, ULM PCI was not an independent risk factor of any clinical adverse events.

Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China

* Lianjun Xu and Zhan Gao contributed equally to the writing of this article.

Correspondence to Jinqing Yuan, MD, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng District, Beijing 100037, People’s Republic of China Tel: +86 108 839 8760; fax: +86 106 835 1786; e-mail: dr_jinqingyuan@sina.com

Received October 10, 2018

Received in revised form January 23, 2019

Accepted January 26, 2019

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