Incidence, Predictors, Treatment, and Long-Term Prognosis of Patients With Restenosis After Drug-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease

Study Questions:

What are the incidence, predictors, and long-term outcome associated with restenosis after drug-eluting stent (DES) placement for unprotected left main artery coronary artery (LMCA) stenosis?

Methods:

The authors reported the outcome of 509 patients who underwent percutaneous coronary intervention (PCI) of the unprotected LMCA at their center over a 4-year period. Routine or clinically indicated surveillance angiography was performed in 402 (80%) patients.

Results:

Angiographic restenosis occurred in 17% of patients. Of the 71 patients with restenosis of the LMCA, 57 patients developed focal restenosis and 14 had diffuse restenosis. Repeat PCI was performed in 41 (56%) patients, coronary artery bypass grafting (CABG) was performed in 10 (14%) patients, and the remainder were treated medically. The median follow-up was 31 months. Over this follow-up period, 86% of patients who were treated for restenosis were free of major adverse events with no deaths, one (2.2%) myocardial infarction (MI), and six (9.5%) repeated target lesion revascularization cases. The incidence of major adverse cardiac events was 14.4% in the medical group, 13.6% in the repeated PCI group, and 10.0% in the CABG group (p = 0.91). Occurrence of DES in-stent restenosis was not associated with a long-term risk of death or MI in multivariate analysis.

Conclusions:

The authors concluded that occurrence of DES restenosis is common in patients undergoing unprotected LMCA stenting.

Perspective:

The currently available large body of observational and more modest-sized randomized data suggest that patients undergoing LMCA stenting have similar risk of death or MI compared with those treated with CABG, while the need for target vessel revascularization is higher with stenting. This study suggests that the DES restenosis, while relatively common, is associated with a relatively benign outcome.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Prognosis, Myocardial Infarction, Follow-Up Studies, Coronary Stenosis, Drug-Eluting Stents, Coronary Artery Bypass, Stents, Percutaneous Coronary Intervention


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