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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Longest Available Clinical Outcomes After Drug-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease

The DELFT (Drug Eluting stent for LeFT main) Registry

Emanuele Meliga, MD^_*,, Hector Manuel Garcia-Garcia, MD, MSc^_*, Marco Valgimigli, MD, PhD, Alaide Chieffo, MD, PhD, Giuseppe Biondi-Zoccai, MD, Andrew O. Maree, MD^||, Stephen Cook, MD^¶, Lindsay Reardon, MD^||, Claudio Moretti, MD, Stefano De Servi, MD^#, Igor F. Palacios, MD, FACC^||, Stephen Windecker, MD^¶, Antonio Colombo, MD, FACC, FESC, Ron van Domburg, PhD^_*, Imad Sheiban, MD and Patrick W. Serruys, MD, PhD, FACC, FESC^_*,_*

^_* Department of Interventional Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, the Netherlands
Department of Interventional Cardiology, S. Giovanni Battista Hospital, University of Turin, Turin, Italy
Department of Interventional Cardiology, S. Anna Hospital, University of Ferrara, Ferrara, Italy
Department of Interventional Cardiology, S. Raffaele Hospital, Milan, Italy
^|| Department of Interventional Cardiology, Massachusetts General Hospital, Boston, Massachusetts
^¶ Department of Interventional Cardiology, University Hospital, Bern, Switzerland
^# Department of Cardiovascular Diseases, Ospedale Civile di Legnano, Legnano (Milan) Italy.

Manuscript received November 6, 2007; revised manuscript received February 28, 2008, accepted March 4, 2008.

^_* Reprint requests and correspondence: Dr. Patrick W. Serruys, Director of the Interventional Cardiology Department, Thoraxcenter, Erasmus Medical Center, Erasmus University, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands. (Email: p.w.j.c.serruys{at}erasmusmc.nl).

Objectives: The purpose of this study was to investigate the long-term safety and efficacy of percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation for unprotected left main coronary artery (ULMCA) disease.

Background: Long-term clinical outcomes after DES implantation for ULMCA disease have not yet been ascertained.

Methods: From April 2002 to April 2004, 358 consecutive patients who underwent PCI with DES implantation for de novo lesions on ULMCA were retrospectively selected and analyzed in 7 European and U.S. tertiary care centers. No patients were excluded from the analysis, and all patients had a minimum follow-up of 3 years.

Results: Technical success rate was 100%. Procedural success rate was 89.6%. After 3 years, major adverse cardiovascular events (MACE)–free survival in the whole population was 73.5%. According to the Academic Research Consortium definitions, cardiac death occurred in 9.2% of patients, and reinfarction, target lesion revascularization (TLR), and target vessel revascularization (TVR) occurred in 8.6%, 5.8%, and 14.2% of patients, respectively. Definite stent thrombosis occurred in 2 patients (specifically at 0 and 439 days). In elective patients, the 3-year MACE-free survival was 74.2%, with mortality, reinfarction, TLR, and TVR rates of 6.2%, 8.3%, 6.6%, and 16%, respectively. In the emergent group the 3-year MACE-free survival was 68.2%, with mortality, reinfarction, TLR, and TVR rates of 21.4%, 10%, 2.8%, and 7.1%, respectively.

Conclusions: Routine DES implantation in ULMCA disease seems encouraging, with favorable long-term clinical results.

Abbreviations and Acronyms   AMI = acute myocardial infarction   BMS = bare-metal stent(s)   CABG = coronary artery bypass grafting   CD = cardiac death   DES = drug-eluting stent(s)   EF = ejection fraction   EuroSCORE = European System for Cardiac Operative Risk Evaluation   HI = hemodynamic instability   IDDM = insulin-dependent diabetes mellitus   MACE = major adverse cardiac event(s)   MI = myocardial infarction   PCI = percutaneous coronary intervention   PES = paclitaxel-eluting stent(s)   SES = sirolimus-eluting stent(s)   ST = stent thrombosis   TLR = target lesion revascularization   TVR = target vessel revascularization   ULMCA = unprotected left main coronary artery

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