BACKGROUND: Whether restenosis remains a major, and potentially fatal, complication after percutaneous intervention for left main coronary artery (LMCA) stenosis and whether routine surveillance angiography should be a necessary part of the follow-up of these patients in current drug eluting stent (DES) era is largely debatable. METHODS AND RESULTS: Patients who underwent elective treatment of unprotected LMCA with DES in three referral centres in Europe were pooled as follows: i) 147 patients treated in Massy, between 12th August 2002 and 31st December 2004; ii) 107 patients, treated in Milan, San Raffaele Hospital and Columbus Clinic, between 16th April 2002 and 31st July 2004; iii) 86 patients treated at the Thoraxcenter, Rotterdam, between 16th April 2002 and 28th June 2004 leading to a total of 340 elective consecutive patients. The rate of in-hospital mortality was 0.6% (2/340). The out-of-hospital event rate in terms of cardiac death or myocardial infarction was 1.2% between discharge and 3 month, 0.6% between three and 6 months and 0.6% between 6 months and 1 year. Two (0.6%) sudden and unexpected deaths were cumulatively observed, at 8 days and 2 months after intervention, respectively. The rate of confirmed or possible stent thrombosis was 0.9%. At 1 year, the out-of-hospital cumulative incidence of cardiac death or MI was 2.4%. In the cohort of patients who refused to undergo angiographic surveillance, no death and no MI occurred. CONCLUSIONS: Cardiac and sudden death and the incidence of stent thrombosis after LMCA intervention with DES were reasonably low and compared favourably with what reported in non-LMCA lesions. At the time intimal hyperplasia is expected to peak (i.e. beyond 6 months), no increase of adverse events, in terms of death or myocardial infarction was observed.
BACKGROUND: Whether restenosis remains a major, and potentially fatal, complication after percutaneous intervention for left main coronary artery (LMCA) stenosis and whether routine surveillance angiography should be a necessary part of the follow-up of these patients in current drug eluting stent (DES) era is largely debatable. METHODS AND RESULTS:Patients who underwent elective treatment of unprotected LMCA with DES in three referral centres in Europe were pooled as follows: i) 147 patients treated in Massy, between 12th August 2002 and 31st December 2004; ii) 107 patients, treated in Milan, San Raffaele Hospital and Columbus Clinic, between 16th April 2002 and 31st July 2004; iii) 86 patients treated at the Thoraxcenter, Rotterdam, between 16th April 2002 and 28th June 2004 leading to a total of 340 elective consecutive patients. The rate of in-hospital mortality was 0.6% (2/340). The out-of-hospital event rate in terms of cardiac death or myocardial infarction was 1.2% between discharge and 3 month, 0.6% between three and 6 months and 0.6% between 6 months and 1 year. Two (0.6%) sudden and unexpected deaths were cumulatively observed, at 8 days and 2 months after intervention, respectively. The rate of confirmed or possible stent thrombosis was 0.9%. At 1 year, the out-of-hospital cumulative incidence of cardiac death or MI was 2.4%. In the cohort of patients who refused to undergo angiographic surveillance, no death and no MI occurred. CONCLUSIONS: Cardiac and sudden death and the incidence of stent thrombosis after LMCA intervention with DES were reasonably low and compared favourably with what reported in non-LMCA lesions. At the time intimal hyperplasia is expected to peak (i.e. beyond 6 months), no increase of adverse events, in terms of death or myocardial infarction was observed.