Transcript Left Main Trifurcation Disease: Early and Long-Term

Left Main Trifurcation Disease:
Early and Long-Term
Outcomes Of Percutaneous
Coronary Intervention
I.Sheiban, A.Gerasimou, F. Sciuto, P.Omedè, G. Biondi
Zoccai, D. Sillano, G.P. Trevi, C. Moretti
Division of Cardiology, University of Turin, Italy
Background
Percutaneous treatment of left main (LM)
trifurcation disease is a challenging
procedure for most interventional
cardiologists. Moreover, data on long-term
outcomes after stent implantation for LM
trifurcation disease are lacking. We thus
conducted a retrospective cohort study
focusing on our 5-year experience on
stenting for LM trifurcation disease.
Methods
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A total of 27 patients underwent percutaneous coronary intervention
with stent implantation for LM trifurcation disease from 11/10/2002 to
02/10/2006 were included.
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Decision to perform PCI instead of surgery was taken on the basis of
comorbidity and high risk score, unsuitable anatomy for surgery (size
and quality of coronary vessels and/or conduits for grafting) and/or
patient refusal of CABG.
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LM trifurcation disease was defined as involvement of LM and at least
one side branch or at least one side branch without LM involvement. 12
patients presented with (44%) true trifurcations, ie with all main and
side branches significantly diseased.
Baseline variables
Male
Mean Age
Diabetes
Hypertension
Hyperlipidemia
Smoke
Previous IMA
Previous CABG
Prior PCI
EF
Euroscore
Procedure
Elective
Urgent
Clinical presentation
AMI
Unstable angina
Stable angina
62%
66.1
14%
92%
81%
25%
37%
7%
22%
53.4±8.25
5.97±3.57
66%
44%
44%
22%
34%
Index procedure and angiographic
variables
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Double antiaggregation
27/100%
IIb/IIIa
3/10%
Total stents/per patient
52/1.8
DES 96%-BMS 29% of patients respectively
Stenting techniques
V stenting
6/21%
T stenting
10/35%
One stent strategy
11/39%
Angiographic variables
LM lesion
26/92%
RVD
3.68±0.37mm
Lesion length
14.8±6.15mm
Lesion class
B2-60%/C-40%
LAD lesion
60%
LCX lesion
46%
RI lesion
50%
Angiographic and procedural caracteristics
Results
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Pre TIMI 1
Post TIMI 3 (angiographic success
100%).
Clinical success 100%.
1 in hospital death (3%).
Clinical follow-up completed on 27 pts (100%).
Angiographic follow-up completed on 22 pts (81%).
Overall MACE 33%
Events at long term follow up
Conclusions
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Recurrence of angina appeared as a major predictor of
poor outcome, as among 6 cases (22%) with recurrent
symptoms, 2 died during follow-up and 2 underwent
surgical bypass.
Percutaneous treatment of LM trifurcation disease is
feasible and associated with favorable mid-term results,
and should be considered given its low invasiveness in
patients at high surgical risk or multiple comorbidities.
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