EBC - ON DEMAND
European Bifurcation Club 2015 – EBC 2015 – Athens, Greece
Left main stenting
10-year Outcome of LM Stenting & Management of Restenosis
Author: I Sheiban, Director Interventional Cardiology, Pederzoli Hospital, Peshiera del Garda ( Verona ) / Italy
BACKGROUND
- Unprotected Left Main disease is burdened by relevant risk of death and MI ( up to 10-15% of pts presenting both with ACS or stable presentation
- CABG has represented the standard of care for these patients for many years, offering if performed with LIMA grafts rates of patency up to 90% at ten years, but very inferior if performed with SVG vein grafts.
- In the last 12 years PCI for LM disease has become widely used offering a feasible alternative
- The 5-year follow up data from the Syntax trial and others : similar rates of MACE in patients treated with PCI vs. CABG for ULM leading to significant change in ESC guidelines for patients with ULM
- Evaluation of long term outcome of PCI vs. CABG is mandatory, but no data have been reported from observational registries on 10 year outcome of PCI on ULM .
FINAL REMARKS
- Despite use of first generation stents, PCI on ULM is safe and efficacy is long lasting over time (10 yrs) with low rates of recurrent events due to index-revascularization.
- Progression of atherosclerotic lesions on other coronary vessels ( and not LM itself) represents the only independent predictive factor for prognosis following index procedure .
- Despite many limitations (observational with mainly a descriptive aim, use of first generation stents), the concept of the PCI on ULM and of its feasibility is the most useful finding.
- In-stent Restenosis , when occurs , can be safely and effectively managed with DES and DCB