Left Main Trifurcation Disease: Early and Long-Term Outcomes Of Percutaneous Coronary Intervention I.Sheiban, A.Gerasimou, F. Sciuto, P.Omedè, G. Biondi Zoccai, D. Sillano, G.P. Trevi, C. Moretti I.Sheiban, A.Gerasimou, F. Sciuto, P.Omedè, G. Biondi Zoccai, D. Sillano, G.P. Trevi, C. Moretti Division of Cardiology, University of Turin, Italy

Background Percutaneous treatment of left main (LM) trifurcation disease is a challenging procedure for most interventional cardiologists. Moreover, data on long-term outcomes after stent implantation for LM trifurcation disease are lacking. We thus conducted a retrospective cohort study focusing on our 5-year experience on stenting for LM trifurcation disease.

Methods A total of 27 patients underwent percutaneous coronary intervention with stent implantation for LM trifurcation disease from 11/10/2002 to 02/10/2006 were included. A total of 27 patients underwent percutaneous coronary intervention with stent implantation for LM trifurcation disease from 11/10/2002 to 02/10/2006 were included. Decision to perform PCI instead of surgery was taken on the basis of comorbidity and high risk score, unsuitable anatomy for surgery (size and quality of coronary vessels and/or conduits for grafting) and/or patient refusal of CABG. Decision to perform PCI instead of surgery was taken on the basis of comorbidity and high risk score, unsuitable anatomy for surgery (size and quality of coronary vessels and/or conduits for grafting) and/or patient refusal of CABG. 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 patients presented with (44%) true trifurcations, ie with all main and side branches significantly diseased. 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 patients presented with (44%) true trifurcations, ie with all main and side branches significantly diseased.

Baseline 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±8.25 EF 53.4±8.25 Euroscore 5.97±3.57 Euroscore 5.97±3.57Procedure Elective 66% Elective 66% Urgent 44% Clinical presentation AMI 44% Unstable angina 22% Stable angina 34%

Index procedure and angiographic variables Double antiaggregation 27/100% Double antiaggregation 27/100% IIb/IIIa 3/10% IIb/IIIa 3/10% Total stents/per patient 52/1.8 Total stents/per patient 52/1.8 DES 96%-BMS 29% of patients respectively DES 96%-BMS 29% of patients respectively Stenting techniques Stenting 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 variables Angiographic variables LM lesion 26/92% LM lesion 26/92% RVD 3.68±0.37mm RVD 3.68±0.37mm Lesion length 14.8±6.15mm Lesion length 14.8±6.15mm Lesion class B2-60%/C-40% Lesion class B2-60%/C-40% LAD lesion 60% LAD lesion 60% LCX lesion 46% LCX lesion 46% RI lesion 50% RI lesion 50%

Angiographic and procedural caracteristics

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

Conclusions Recurrence of angina appeared as a major predictor of poor outcome, as among 6 cases (22%) with recurrent symptoms, 2 died during follow-up and 2 underwent surgical bypass. Recurrence of angina appeared as a major predictor of poor outcome, as among 6 cases (22%) with recurrent symptoms, 2 died during follow-up and 2 underwent surgical bypass. Percutaneous treatment of LM trifurcation disease is feasible and associated with favorable mid-term results, and should be considered given its low invasiveness in patients at high surgical risk or multiple comorbidities. Percutaneous treatment of LM trifurcation disease is feasible and associated with favorable mid-term results, and should be considered given its low invasiveness in patients at high surgical risk or multiple comorbidities.

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