Key result
True unprotected distal left main trifurcation lesions were associated with a higher risk of MACE at 3 years compared to non-true lesions (HR 2.801; 95% CI 1.164-7.896; P=0.025).
Why the study?
Does true ULMT disease increase the risk of MACE compared to non-true ULMT disease in patients undergoing PCI with DES?
Cohort (n=84)
Yes
Does true ULMT disease increase the risk of MACE compared to non-true ULMT disease in patients undergoing PCI with DES?
Hazard Ratio: 2.801 (95% CI 1.164–7.896)
p-value: p=0.025
PCI with DES for unprotected distal left main trifurcation is feasible, but true trifurcation lesions are associated with a higher risk of MACE at 3 years, primarily driven by target lesion revascularization.
May warrant closer post-PCI surveillance for true lesions; leaves open optimal strategies pending prospective trials.
BACKGROUND: Unprotected distal left main trifurcation (ULMT) lesion represents a challenge for interventional cardiologists with the potential for peri-procedural complications and adverse events at follow-up especially when the main branch and the side branches are concomitantly diseased. METHODS: A retrospective cohort analysis was performed on consecutive patients with ULMT stenosis who electively underwent percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation in order to assess the technical feasibility and long-term outcomes according to the disease distribution in the trifurcation branches (true vs. non-true ULMT). Primary endpoint of the study was a composite of major adverse cardiovascular events (MACE) defined as cardiac-death, myocardial infarction (MI), and target lesion revascularization (TLR) during follow-up. RESULTS: Eighty-four patients underwent PCI with DES for ULMT disease during the study period (40 true trifurcation and 44 non-true trifurcation). Angiographic and procedural success were obtained in 94% and 92.8% of cases. At 3-years follow-up, the occurrence of MACE was significantly higher in patients with true ULMT than in those with non-true ULMT (HR 2.801 [confidence interval; CI 1.164-7.896], P = 0.025) due to a higher TLR rate (HR 3.032 [CI 1.164-7.896], P = 0.023). No episodes of late and very late definite/probable stent thrombosis (ST) occurred. On multivariable analysis, a true-ULMT lesion was the only independent predictor of MACE (HR 2.344 [C.I. 1.006-5.461], P = 0.049). CONCLUSIONS: PCI with DES for ULMT stenosis is feasible with a high procedural success rate and no definite/probable ST reported at follow-up. A true trifurcation lesion is associated with enhanced risk of MACE mainly driven by TLR.
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Ielasi et al. (2013) conducted a cohort in Unprotected distal left main trifurcation (ULMT) stenosis (n=84). True ULMT lesion vs. Non-true ULMT lesion was evaluated on Composite of major adverse cardiovascular events (MACE) defined as cardiac-death, myocardial infarction (MI), and target lesion revascularization (TLR) (HR 2.801, 95% CI 1.164-7.896, p=0.025). True unprotected distal left main trifurcation lesions were associated with a higher risk of MACE at 3 years compared to non-true lesions (HR 2.801; 95% CI 1.164-7.896; P=0.025).