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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Early and Long-Term Results of Unprotected Left Main Coronary Artery Stenting

The LE MANS (Left Main Coronary Artery Stenting) Registry

Pawel E. Buszman, MD^_*,,,_*, Piotr P. Buszman, MD^_*,, R. Stefan Kiesz, MD, Andrzej Bochenek, MD^_*,, Blazej Trela, MD^_*, Magda Konkolewska, MD^_*, David Wallace-Bradley, BS^||, Mirosaw Wilczyski, MD, Iwona Banasiewicz-Szkróbka, MD, Ewa Peszek-Przybyla, MD, Marek Krol, MD, Marek Kondys, MD^¶, Krzysztof Milewski, MD^,||, Szymon Wiernek, MD^_*,, Marcin Dbiski, MD, Aleksander urakowski, MD, Jack L. Martin, MD^,# and Micha Tendera, MD^_*,

^_* Medical University of Silesia, Katowice, Poland
Upper-Silesian Heart Centre, Katowice, Poland
American Heart of Poland, Ustron, Poland
San Antonio Endovascular and Heart Institute and University of Texas Health Science Center at San Antonio, San Antonio, Texas
^|| Cardiovascular Research Foundation, New York, New York
^¶ American Heart of Poland, Dabrowa Gornicza, Poland
^# Thomas Jefferson University, Philadelphia, Pennsylvania

Manuscript received March 16, 2009; revised manuscript received July 7, 2009, accepted July 12, 2009.

^_* Reprint requests and correspondence: Dr. Pawel E. Buszman, Katowice 40-635, Ziolowa 45/47 Street, Poland (Email: pbuszman{at}ka.onet.pl).

Objectives: The aim of the study was to evaluate early and late outcomes after percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCA) and to compare bare-metal stent (BMS) and drug-eluting stent (DES) subgroups.

Background: PCI is an increasingly utilized method of revascularization in patients with ULMCA.

Methods: This multicenter prospective registry included 252 patients after ULMCA stenting enrolled between March 1997 and February 2008. Non–ST-segment elevation acute coronary syndrome was diagnosed in 58% of patients; ST-segment elevation myocardial infarction cases were excluded. Drug-eluting stents were implanted in 36.2% of patients.

Results: Major adverse cardiovascular and cerebral events (MACCE) occurred in 12 (4.8%) patients during the 30-day period, which included 4 (1.5%) deaths. After 12 months there were 17 (12.1%) angiographically confirmed cases of restenosis. During long-term follow-up (1 to 11 years, mean 3.8 years) there were 64 (25.4%) MACCE and 35 (13.9%) deaths. The 5- and 10-year survival rates were 78.1% and 68.9%, respectively. Despite differences in demographical and clinical data in favor of BMS patients, unmatched analysis showed a significantly lower MACCE rate in DES patients (25.9% vs. 14.9%, p = 0.039). This difference was strengthened after propensity score matching. The DES lowered both mortality and MACCE for distal ULMCA lesions when compared with BMS. Ejection fraction <50% was the only independent risk factor influencing long-term survival.

Conclusions: Stenting of ULMCA is feasible and offers good long-term outcome. Implantation of DES for ULMCA decreased the risk of long-term MACCE, and particularly improved survival in patients with distal ULMCA disease.

Key Words: unprotected left main coronary artery disease • percutaneous coronary intervention • drug-eluting stent • bare-metal stent

Abbreviations and Acronyms   BMS = bare-metal stent(s)   CABG = coronary artery bypass grafting   CI = confidence interval   DES = drug-eluting stent(s)   LM = left main coronary artery   LVEF = left ventricular ejection fraction   MACCE = major adverse cardiovascular and cerebral event   NSTE-ACS = non–ST-segment acute coronary syndrome   OR = odds ratio   PCI = percutaneous coronary intervention   TLR = target lesion revascularization   ULMCA = unprotected left main coronary artery

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