Long-Term Follow-Up After Nonurgent Percutaneous Coronary Intervention in Unprotected Left Main Coronary Arteries Marcel A.M. Beijk, 1 MD, Saskia Z.H. Rittersma, 1 MD, PhD, Karel T. Koch, 1 MD, PhD, Jose ´ P.S. Henriques, 1 MD, PhD, Jan Baan, 1 MD, PhD, Marije M. Vis, 1 MD, Fokje Hoekstra, 1 RN, Jan G.P. Tijssen, 1 PhD, Jan J. Piek, 1 MD, PhD, Jaap J. Kloek, 2 MD, Bas A.J.M. de Mol, 2 MD, PhD, and Robbert J. de Winter, 1 * MD, PhD Objectives: To evaluate the long-term outcomes of the selected patients by the local Heart Team to undergo percutaneous coronary intervention (PCI) of unprotected left main coronary artery (ULMCA) stenosis and to compare patients considered at low surgical risk versus at high surgical risk for coronary artery bypass grafting (CABG). Background: CABG is recommended in patients with ULMCA stenosis according to the AHA/ACC and ESC guidelines, and there are limited data on the long-term outcomes in patients selected by the local Heart Team to undergo PCI. Methods: Between 1996 and 2007, 227 patients underwent PCI for ULMCA stenosis based on decision of the local Heart Team and patient’s and/or physician’s preference. All patients were con- tacted at 1 year and in November 2008. Results: Long-term follow-up was up to 8 years with a mean of 3.9 6 2.6 years. Overall, the Kaplan–Meier estimate of the composite of cardiac death, myocardial infarction (MI), or target lesion revascularization (TLR) was 14.8% at 1 year, 18.3% at 3 years, and 20.9% at 5 years with no events occurring there- after. Patients considered at low surgical risk for CABG had a significantly lower inci- dence of cardiac death or MI compared to patients considered at high surgical risk at 8 years (1.4 vs. 16.8%; 1.4 vs. 14.8%, respectively); however, no significant difference was observed for cardiac death, MI, or TLR (18.6 vs. 24.4%). Conclusions: PCI of ULMCA stenosis in patients selected by the Heart Team resulted in good long-term clinical outcomes with most events occurring within the 1st year. Patients considered at low surgical risk for CABG have a significantly better long-term survival than patients at high risk for surgery. V C 2010 Wiley-Liss, Inc. Key words: unprotected left main coronary artery; stenosis; percutaneous coronary intervention; stents INTRODUCTION Coronary artery bypass grafting (CABG) has been the standard treatment for significant unprotected left main coronary artery (ULMCA) stenosis since the late 1970s and is recommended as first choice therapy by the ACC/AHA [1] and ESC [2] guidelines for percuta- neous coronary interventions (PCI). PCI of ULMCA stenosis is recommended only as an alternative for sta- ble patients who are considered not eligible for sur- gery. Several studies have reported increasingly good immediate and long-term outcomes of ULMCA stent- ing with bare-metal stents (BMSs) [3–10] So far, long- term outcomes based on the pre-PCI estimated surgical risk have not been ecaluated. In recent years when drug-eluting stents (DESs) became available, the indi- cations for PCI have extended to patients with complex 1 Department of Cardiology, Academic Medical Center, Univer- sity of Amsterdam, Amsterdam, The Netherlands 2 Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Nether- lands Conflict of interest: Nothing to report. *Correspondence to: Robbert J. de Winter, MD, PhD, Department of Cardiology, Academic Medical Center, University of Amsterdam, B2-137, Meibergdreef 9, PO BOX 22660, AZ Amsterdam 1105, The Netherlands. E-mail: r.j.dewinter@amc.uva.nl Received 7 September 2009; Revision accepted 24 November 2009 DOI 10.1002/ccd.22404 Published online 13 April 2010 in Wiley InterScience (www. interscience.wiley.com) V C 2010 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 75:1026–1036 (2010)