Results of percutaneous drug‐eluting stent implantation for unprotected left main coronary disease according to left ventricular systolic function

OBJECTIVES: We aimed to appraise the early and long-term outcome after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with unprotected left main disease (ULM) and left ventricular systolic dysfunction (LVD). BACKGROUND: PCI with DES has being performed with increasing frequency in subjects with ULM and LVD, but few specific data are available. SETTING AND PATIENTS: We identified patients undergoing PCI with DES for ULM at our Center and distinguished those with ejection fraction (EF) >50% from those with 40% <EF <or=50% and those with EF <or=40%. The primary end-point was the rate of major adverse cerebro-cardiovascular events (MACCE, ie death, myocardial infarction [MI], stroke, repeat PCI or bypass surgery). RESULTS: A total of 197 patients were included, 57.4% with EF >50%, 32.0% with 40% <EF <or=50%, and 10.6% with EF <or=40%. In-hospital mortality was significantly higher in those with EF <or=40% (9.5% vs. 0 and 3.2%, P < 0.001). A total of 96% patients were followed for 23 +/- 14 months, yielding a MACCE rate of 44.2% (41.6% in those with EF >50%, 41.6% in those with 40% <EF <or=50%, and 61.9% in those with EF <or=40%, P = 0.4). Specifically, death occurred in 2.7%, 7.9%, and 28.6% (P < 0.001), cardiac death in 1.8%, 4.8%, and 23.8% (P = 0.001), MI in 8.0%, 7.9% and 0 (P = 0.4), and TVR in 15.9%, 11.1% and 33.3% (P = 0.6). CONCLUSION: Systolic ventricular dysfunction is highly correlated with in-hospital and long term death rates in patients undergoing PCI with DES for ULM disease. However it does not confer an increased risk of nonfatal adverse events or stent thrombosis.