OBJECTIVES: The aim of this study was to evaluate the incidence, predictors, and long-term outcomes of patients with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main coronary artery (LMCA) disease. BACKGROUND: Few data on the clinical course and management of patients experiencing restenosis after DES treatment for unprotected LMCA disease have appeared. METHODS: Between February 2003 and November 2007, 509 consecutive patients with unprotected LMCA disease underwent DES implantation, with 402 (80.1%) undergoing routine surveillance or clinically driven angiographic follow-up. A major adverse cardiac event was defined as the composite of death, myocardial infarction (MI), or target-lesion revascularization. RESULTS: The overall incidence of angiographic ISR in LMCA lesions was 17.6% (71 of 402 patients, 57 with focal-type and 14 with diffuse-type ISR. Forty patients (56.3%) underwent repeated PCI, 10 (14.1%) underwent bypass surgery, and 21 (29.6%) were treated medically. During long-term follow-up (a median of 31.7 months), there were no deaths, 1 (2.2%) MI, and 6 (9.5%) repeated target-lesion revascularization cases. The incidence of major adverse cardiac event was 14.4% in the medical group, 13.6% in the repeated PCI group, and 10.0% in the bypass surgery group (p = 0.91). Multivariate analysis showed that the occurrence of DES-ISR did not affect the risk of death or MI. CONCLUSIONS: The incidence of ISR was 17.7% after DES stenting for LMCA. The long-term clinical prognosis of patients with DES-ISR associated with LMCA stenting might be benign, given that these patients were optimally treated with the clinical judgment of the treating physician.
OBJECTIVES: The aim of this study was to evaluate the incidence, predictors, and long-term outcomes of patients with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main coronary artery (LMCA) disease. BACKGROUND: Few data on the clinical course and management of patients experiencing restenosis after DES treatment for unprotected LMCA disease have appeared. METHODS: Between February 2003 and November 2007, 509 consecutive patients with unprotected LMCA disease underwent DES implantation, with 402 (80.1%) undergoing routine surveillance or clinically driven angiographic follow-up. A major adverse cardiac event was defined as the composite of death, myocardial infarction (MI), or target-lesion revascularization. RESULTS: The overall incidence of angiographic ISR in LMCA lesions was 17.6% (71 of 402 patients, 57 with focal-type and 14 with diffuse-type ISR. Forty patients (56.3%) underwent repeated PCI, 10 (14.1%) underwent bypass surgery, and 21 (29.6%) were treated medically. During long-term follow-up (a median of 31.7 months), there were no deaths, 1 (2.2%) MI, and 6 (9.5%) repeated target-lesion revascularization cases. The incidence of major adverse cardiac event was 14.4% in the medical group, 13.6% in the repeated PCI group, and 10.0% in the bypass surgery group (p = 0.91). Multivariate analysis showed that the occurrence of DES-ISR did not affect the risk of death or MI. CONCLUSIONS: The incidence of ISR was 17.7% after DES stenting for LMCA. The long-term clinical prognosis of patients with DES-ISR associated with LMCA stenting might be benign, given that these patients were optimally treated with the clinical judgment of the treating physician.
Authors: Wojciech Wańha; Jacek Bil; Michalina Kołodziejczak; Adam Kowalówka; Mariusz Kowalewski; Damian Hudziak; Radosław Gocoł; Rafał Januszek; Tomasz Figatowski; Marek Milewski; Brunon Tomasiewicz; Piotr Kübler; Bruno Hrymniak; Piotr Desperak; Łukasz Kuźma; Krzysztof Milewski; Bartłomiej Góra; Andrzej Łoś; Jan Kulczycki; Adrian Włodarczak; Wojciech Skorupski; Marek Grygier; Maciej Lesiak; Fabrizio D'Ascenzo; Marek Andres; Paweł Kleczynski; Radosław Litwinowicz; Andrea Borin; Grzegorz Smolka; Krzysztof Reczuch; Marcin Gruchała; Robert J Gil; Miłosz Jaguszewski; Krzysztof Bartuś; Piotr Suwalski; Sławomir Dobrzycki; Dariusz Dudek; Stanisław Bartuś; Mariusz Ga Sior; Andrzej Ochała; Alexandra J Lansky; Marek Deja; Jacek Legutko; Elvin Kedhi; Wojciech Wojakowski Journal: Front Cardiovasc Med Date: 2022-04-29