Methods : there is long-term comparative clinical outcome data of percutaneous coronary intervention (PCI) in unprotected left main coronary artery (LMCA) disease treated with the single (provisional-T) stent technique in the drug-eluting stent (DES). The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR). Data from a single center registry, which included 189 patients, who ULMCA PCI with different generations DES. All interventions were conducted by final «kissing-balloon» dilatation with high pressure balloons and under IVUS/OCT guidence. Long-term results were assessed by following criteria: frequency of MACE (death, myocardial infarction, re-intervention), IVUS//OCT data (residual area of vessel lumen in the proximal segment of LM, zone of bifurcation, the ostia of LAD and LCx).
Results : there were 72 patients receiving everolimus-eluting stent (EES) second generation («Xience V»), 68 patients receiving biolimus-eluting stent (BES) third generation («Nobori»), and 49 patients receiving everolimus-eluting stent (EES) IVth generation («Synergy»). During 12-months follow-up, the PS adjusted Cox-proportional hazard ratio (HR) was not significantly different between the three groups for total death, cardiac death, TLR and MI. The narrowing of LCX ostial area at follow-up was more pronounced in BES compared with EES (13.2% vs. 2.5%, respectively, p<0.001). Linear regression analysis showed a high correlation between the number of stent struts in LCX ostium and ostial area narrowing (r=0.771, p<0.001). Re-intervention was required in the LCX ostial area only in 3,1% of cases in group second generation EES and in 5,6% of third generation BES. During 3-years follow-up, there was no statistical difference in major adverse cardiovascular events, cardiac death, myocardial infarction and stent thrombosis between the groups different generations stents (HR: 0.63, 95% Confidence interval (CI): 0.33-1.17; P = 0.149).
Conclusions : The endovascular treatment of patients with unprotected left main bifurcation lesions with different generations of drug-eluting stents is associated with good long-term clinical outcomes. Clinical outcome seems to be independent of lesion complexity and the number of stent struts in LCX ostium. There are no differences in clinical events among patients receiving different generation drug-eluting stents for ULMCA disease.