Impact of previous drug-eluting stent restenosis in non-left main coronary artery lesions on long-term outcomes after left main coronary artery stenting: an observation from the AOI-LMCA registry

We hypothesized that patients who had previous target-lesion revascularization (TLR) for DES restenosis in non-left main coronary artery (LMCA) lesions might have a higher risk for restenosis after subsequent DES implantation for a de novo unprotected LMCA lesion. Among 1809 patients enrolled in the Assessing Optimal Percutaneous Coronary Intervention for LMCA (AOI-LMCA) registry, which is a retrospective 6-centre registry of consecutive patients undergoing LMCA stenting in Japan, 251 patients with previous DES implantation for non-LMCA lesions were subdivided into the 2 groups with ( N = 56) or without ( N = 195) previous TLR in non-LMCA lesions. The risk for TLR for LMCA was neutral between the prior TLR for DES restenosis group and the no prior TLR for DES restenosis group [hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.44–2.02, P = 0.98]. The risks for both TLR caused by restenosis of the LMCA main branch, and second TLR for restenosis after first TLR for LMCA were also neutral between the 2 groups (HR 0.42, 95% CI 0.10–1.25, P = 0.13, and HR 0.59, 95% CI 0.03–3.63, P = 0.60, respectively). In conclusion, prior TLR for DES restenosis in non-LMCA lesions was not associated with worse long-term clinical outcomes after DES implantation for de novo unprotected LMCA lesions. Clinical Trial Registration: Assessing Optimal Percutaneous Coronary Intervention for Left Main Coronary Artery Stenting Registry (AOI LMCA Stenting Registry). http://www.umin.ac.jp/ctr/index/htm/ . Unique Identifier: UMIN000014706.