Experience with zotarolimus eluting stent in left main percutaneous coronary intervention at a very long-term follow-up

Type of funding sources: None.

Drug eluting stents (DES) has improved the results of percutaneous coronary intervention (PCI) in terms of safety and effectiveness in left main coronary artery (LMCA) disease. Zotarolimus is a second-generation drug with excellent clinical outcomes but nowadays their results are unclear in this subgroup of high-risk coronary lesions.

The main objective of this study was to evaluate the efficacy and safety of zotarolimus eluting stent (ZES) in LMCA disease at 14-year follow-up.

We prospectively included 432 consecutive patients (69 ± 12 years, 75.5% male) with LMCA disease treated with PCI and ZES between June 2006 and June 2020. We evaluated the presence of major adverse cardiovascular events (MACE) defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis, after 14-year clinical follow-up (median 61 months).

52.8% of patients had stable coronary disease and 47.2% acute coronary syndrome (38.2% Non-STEMI and 9% STEMI). 40.7% were diabetic patients and 40.8% presented moderate-severe left ventricular systolic dysfunction. 5.8% were protected LMCA and 81.7% bifurcated lesions. An intra-aortic balloon pump was needed in 4.9% of the cases. Mean logistic EuroSCORE was 6.7% and Syntax score was ≥ 23 in 73.1% of patients. The most frequently bifurcation technique employed in LMCA was "provisional stenting" in 67.1% of cases with an angiographic success of 99.3%. Complication rate in the procedure was 4.6% with one intraoperative death. During follow-up, MACE rate at 14 years was 17.4% (12.5% cardiac death, 3.5% nonfatal myocardial infarction, 4.2% TLR and thrombosis rate 0.5%). We observed significant differences in the occurrence of MACE in diabetic patients (p=0.002), chronic kidney insufficiency (p<0.001), severe left ventricular systolic dysfunction (p<0.001) and patients in which we didn´t perform final kissing balloon (p=0.03). 21.07% of patients had an angiographic follow-up.

PCI treatment with ZES in LMCA disease is safe and effective with a low rate of immediate complications and a low rate of mayor cardiac events at very long-term follow-up. Patients with diabetes mellitus or chronic kidney insifficiency, severe left ventrcular systolic dysfinction or those in wich didn´t performe a final kissing balloon have worse prognosis.