BACKGROUND: Most cardiologists performing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main disease (ULM) mandate mid-term angiographic follow-up, yet there are few data supporting this approach. We aimed to retrospectively compare the outcome of patients with ULM treated with DES according to their follow-up management strategy. METHODS: Patients with ULM stenosis undergoing PCI with DES and surviving up to 6 months were retrospectively identified from our ongoing database. We distinguished those undergoing clinical follow-up only, those with clinically driven angiographic follow-up, and those with routine angiographic follow-up. The primary end-point was the long-term rate of major adverse cardiac events (MACE, i.e., death, myocardial infarction, bypass surgery, or repeat ULM PCI). RESULTS: A total of 198 patients were included: 55 (28%) in the clinical follow-up group, 64 (32%) in the clinically driven angiographic follow-up group, and 79 (40%) in the routine angiographic follow-up group. After 37.0 +/- 15.7 months, mortality was similar in the 3 groups (respectively 7.3, 4.7, and 5.9%, p = 0.27). However, MACE were significantly more common in the clinically driven angiographic follow-up group (42.2 vs. 7.3 and 26.1%, p = 0.02), mainly due to the expected increase in repeat revascularization in those undergoing angiographic follow-up (23.4 vs. 1.8 and 13.14%). Notably, there were no differences in the rate of stent thrombosis across the three groups, with rates of 3.1 vs. 1.8 and 2.5% (p = 0.35). CONCLUSIONS: An expectant management can be safely adopted in most patients with ULM treated percutaneously, as long as a low threshold for control coronary angiography is maintained.
BACKGROUND: Most cardiologists performing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main disease (ULM) mandate mid-term angiographic follow-up, yet there are few data supporting this approach. We aimed to retrospectively compare the outcome of patients with ULM treated with DES according to their follow-up management strategy. METHODS:Patients with ULM stenosis undergoing PCI with DES and surviving up to 6 months were retrospectively identified from our ongoing database. We distinguished those undergoing clinical follow-up only, those with clinically driven angiographic follow-up, and those with routine angiographic follow-up. The primary end-point was the long-term rate of major adverse cardiac events (MACE, i.e., death, myocardial infarction, bypass surgery, or repeat ULM PCI). RESULTS: A total of 198 patients were included: 55 (28%) in the clinical follow-up group, 64 (32%) in the clinically driven angiographic follow-up group, and 79 (40%) in the routine angiographic follow-up group. After 37.0 +/- 15.7 months, mortality was similar in the 3 groups (respectively 7.3, 4.7, and 5.9%, p = 0.27). However, MACE were significantly more common in the clinically driven angiographic follow-up group (42.2 vs. 7.3 and 26.1%, p = 0.02), mainly due to the expected increase in repeat revascularization in those undergoing angiographic follow-up (23.4 vs. 1.8 and 13.14%). Notably, there were no differences in the rate of stent thrombosis across the three groups, with rates of 3.1 vs. 1.8 and 2.5% (p = 0.35). CONCLUSIONS: An expectant management can be safely adopted in most patients with ULM treated percutaneously, as long as a low threshold for control coronary angiography is maintained.
Authors: F Roques; S A Nashef; P Michel; E Gauducheau; C de Vincentiis; E Baudet; J Cortina; M David; A Faichney; F Gabrielle; E Gams; A Harjula; M T Jones; P P Pintor; R Salamon; L Thulin Journal: Eur J Cardiothorac Surg Date: 1999-06 Impact factor: 4.191
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Authors: Grigorios Korosoglou; Arnt V Kristen; Martin Andrassy; Hugo A Katus; Stefan E Hardt Journal: Clin Res Cardiol Date: 2012-04 Impact factor: 5.460
Authors: Giuseppe Biondi-Zoccai; Imad Sheiban; Enrico Romagnoli; Stefano De Servi; Corrado Tamburino; Antonio Colombo; Francesco Burzotta; Patrizia Presbitero; Leonardo Bolognese; Leonardo Paloscia; Paolo Rubino; Gennaro Sardella; Carlo Briguori; Luigi Niccoli; Gianfranco Franco; Domenico Di Girolamo; Luigi Piatti; Cesare Greco; Davide Capodanno; Giuseppe Sangiorgi Journal: Clin Res Cardiol Date: 2011-06-24 Impact factor: 5.460
Authors: Eva S Kehmeier; Wolfgang Lepper; Martina Kropp; Christian Heiss; Ulrike Hendgen-Cotta; Jan Balzer; Mirja Neizel; Christian Meyer; Marc W Merx; Pablo E Verde; Christian Ohmann; Gerd Heusch; Malte Kelm; Tienush Rassaf Journal: Clin Res Cardiol Date: 2012-05-06 Impact factor: 5.460