Study Supports PCI With DES to Treat Unprotected Left Main Disease

June 22, 2011—The Society for Cardiovascular Angiography and Interventions announced the publication of study results demonstrating favorable outcomes for patients with normal left ventricular function who undergo elective unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Michael S. Lee, MD, et al published the results of the multicenter, retrospective study in Catheterization and Cardiovascular Interventions (2011;77:945–951).

The background of the study is that coronary artery bypass grafting (CABG) is the standard of care to treat patients with ULMCA disease based on medical evidence that shows a survival advantage with this intervention. Current guidelines for PCI state that ULMCA stenting may be an option for patients who are at high risk for adverse surgical outcomes, but who have a low risk for procedural complications. In patients with severe aortic calcification, cerebrovascular disease, or limited life expectancy, angioplasty may be elected over CABG.

In the study, the investigators evaluated the safety and efficacy of ULMCA PCI with DES in patients with normal left ventricular function. The investigators used data from a multicenter international registry, identifying 221 patients who underwent elective PCI for ULMCA disease between 2002 and 2009. Patients in the study had a mean age of 68 years, 75% were men, 25% had diabetes, 39% had a history of heart attack, and 40% had a previous PCI.

“Our analysis confirms that elective PCI with DES in patients with normal left ventricular function is a safe and effective treatment for ULMCA disease,” commented Dr. Lee.

In the first 30 days after angioplasty, there were no reported incidents of cardiac death, target lesion revascularization, stent thrombosis, or stroke. There were no cases of Q-wave myocardial infarction, but seven patients had periprocedural myocardial infarction. The event-free survival estimates for cardiac death and target lesion revascularization at 5 years were 96% and 89%, respectively. Further analysis established that patient age of 75 years or older and a history of myocardial infarction were independent predictors of cardiac death.

“Research comparing the safety and efficacy of ULMCA PCI with DES versus CABG are needed and results from a large multicenter trial are forthcoming,” concluded Dr. Lee. “ULMCA PCI may be a viable option for low-risk patients with normal left ventricular function.”