Revisiting the incidence and temporal distribution of cardiac and sudden death in patients undergoing elective intervention for unprotected left main coronary artery stenosis in the drug eluting stent era

EuroIntervention. 2007 Feb;2(4):435-43.


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.