Left Main Trifurcation Disease: Left Main Trifurcation Disease: Early and Long-Term Early and Long-Term

Outcomes Of Percutaneous Outcomes Of Percutaneous Coronary InterventionCoronary Intervention

I.Sheiban, A.Gerasimou, F. Sciuto, P.Omedè, G. Biondi I.Sheiban, A.Gerasimou, F. Sciuto, P.Omedè, G. Biondi Zoccai, D. Sillano, G.P. Trevi, C. MorettiZoccai, D. Sillano, G.P. Trevi, C. Moretti

Division of Cardiology, University of Turin, ItalyDivision of Cardiology, University of Turin, Italy

BackgroundBackground

Percutaneous treatment of left main (LM) Percutaneous treatment of left main (LM) trifurcation disease is a challenging trifurcation disease is a challenging procedure for most interventional procedure for most interventional

cardiologists. Moreover, data on long-term cardiologists. Moreover, data on long-term outcomes after stent implantation for LM outcomes after stent implantation for LM trifurcation disease are lacking. We thus trifurcation disease are lacking. We thus conducted a retrospective cohort study conducted a retrospective cohort study focusing on our 5-year experience on focusing on our 5-year experience on stenting for LM trifurcation disease.stenting for LM trifurcation disease.

MethodsMethods A total of 27 patients underwent percutaneous coronary intervention A total of 27 patients underwent percutaneous coronary intervention

with stent implantation for LM trifurcation disease from 11/10/2002 to with stent implantation for LM trifurcation disease from 11/10/2002 to 02/10/2006 were included.02/10/2006 were included.

Decision to perform PCI instead of surgery was taken on the basis of Decision to perform PCI instead of surgery was taken on the basis of comorbidity and high risk score, unsuitable anatomy for surgery (size comorbidity and high risk score, unsuitable anatomy for surgery (size and quality of coronary vessels and/or conduits for grafting) and/or and quality of coronary vessels and/or conduits for grafting) and/or patient refusal of CABG.patient refusal of CABG.

LM trifurcation disease was defined as involvement of LM and at least 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 one side branch or at least one side branch without LM involvement. 12 patients presented with (44%) true trifurcations, ie with all main and patients presented with (44%) true trifurcations, ie with all main and side branches significantly diseased.side branches significantly diseased.

Baseline variablesBaseline variables Male 62%Male 62%

Mean Age 66.1 Mean Age 66.1

Diabetes 14%Diabetes 14%

Hypertension 92%Hypertension 92%

Hyperlipidemia 81%Hyperlipidemia 81%

Smoke 25%Smoke 25%

Previous IMA 37%Previous IMA 37%

Previous CABG 7%Previous CABG 7%

Prior PCI 22%Prior PCI 22%

EF 53.4±8.25EF 53.4±8.25

Euroscore 5.97±3.57Euroscore 5.97±3.57

ProcedureProcedure

Elective 66%Elective 66%

Urgent 44%Urgent 44%

Clinical presentationClinical presentation

AMI 44%AMI 44%

Unstable angina 22%Unstable angina 22%

Stable angina 34%Stable angina 34%

Index procedure and angiographic Index procedure and angiographic variablesvariables

Double antiaggregation 27/100%Double antiaggregation 27/100% IIb/IIIa 3/10%IIb/IIIa 3/10% Total stents/per patient 52/1.8Total stents/per patient 52/1.8 DES 96%-BMS 29% of patients respectively DES 96%-BMS 29% of patients respectively Stenting techniquesStenting techniques V stenting 6/21%V stenting 6/21% T stenting 10/35%T stenting 10/35% One stent strategy 11/39%One stent strategy 11/39% Angiographic variablesAngiographic variables LM lesion 26/92%LM lesion 26/92% RVD 3.68±0.37mmRVD 3.68±0.37mm Lesion length 14.8±6.15mm Lesion length 14.8±6.15mm Lesion class B2-60%Lesion class B2-60%//C-40%C-40% LAD lesion 60%LAD lesion 60% LCX lesion 46%LCX lesion 46% RI lesion 50%RI lesion 50%

Angiographic and procedural caracteristics Angiographic and procedural caracteristics

Results Results

Pre TIMI 1 Post TIMI 3 (angiographic success Pre TIMI 1 Post TIMI 3 (angiographic success 100%).100%).

Clinical success 100%.Clinical success 100%. 1 in hospital death (3%).1 in hospital death (3%). Clinical follow-up completed on 27 pts (100%).Clinical follow-up completed on 27 pts (100%). Angiographic follow-up completed on 22 pts (81%). Angiographic follow-up completed on 22 pts (81%). Overall MACE 33%Overall MACE 33%

Events at long term follow upEvents at long term follow up

ConclusionsConclusions Recurrence of angina appeared as a major predictor of Recurrence of angina appeared as a major predictor of

poor outcome, as among 6 cases (22%) with recurrent poor outcome, as among 6 cases (22%) with recurrent symptoms, 2 died during follow-up and 2 underwent symptoms, 2 died during follow-up and 2 underwent

surgical bypass.surgical bypass.

Percutaneous treatment of LM trifurcation disease is Percutaneous treatment of LM trifurcation disease is feasible and associated with favorable mid-term results, feasible and associated with favorable mid-term results, and should be considered given its low invasiveness in and should be considered given its low invasiveness in patients at high surgical risk or multiple comorbidities.patients at high surgical risk or multiple comorbidities.

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