BACKGROUND: In-stent restenosis (ISR) remains one of the main limitations for percutaneous coronary intervention of unprotected distal left main (UDLM). This study aims to demonstrate the impact of main-branch ISR (MB-ISR) on mortality and to clarify the optimal strategy. METHODS: Between 2002 and 2008, 482 consecutive UDLM patients treated with drug eluting stent (sirolimus and paclitaxel) were evaluated. RESULTS: During follow-up period (median 52.6 months), MB-ISR occurred in 29, SB-ISR in 65, and MB/SB-ISR in 24. Multivariable analysis demonstrated that the independent predictors of MB-ISR were calcification (HR 2.284, p = 0.016), true-bifurcation (HR 2.331, p = 0.024), insulin-dependent diabetes mellitus (insulin-DM) (HR 2.259, p = 0.048). Furthermore, final proximal postdilatation (FPPD) (HR 0.548, p = 0.077), full LM cover approach (FCA) (HR 0.605, p = 0.093) and greater MLD (HR 0.611, p = 0.062) had a tendency to reduce MB-ISR. Furthermore, the occurrence of MB-ISR within 1-year was associated with cardiac-death (HR 2.734, p = 0.017). CONCLUSIONS: The patients with MB-ISR had more comorbidities and complex lesions, resulting in higher risk of cardiac mortality as compared to the patients without MB-ISR. Presence of calcification, true-bifurcation and insulin-DM were associated with MB-ISR following UDLM intervention, while FCA, FPPD, and greater MLD seemed to be associated with the low occurrence of MB-ISR.
BACKGROUND: In-stent restenosis (ISR) remains one of the main limitations for percutaneous coronary intervention of unprotected distal left main (UDLM). This study aims to demonstrate the impact of main-branch ISR (MB-ISR) on mortality and to clarify the optimal strategy. METHODS: Between 2002 and 2008, 482 consecutive UDLM patients treated with drug eluting stent (sirolimus and paclitaxel) were evaluated. RESULTS: During follow-up period (median 52.6 months), MB-ISR occurred in 29, SB-ISR in 65, and MB/SB-ISR in 24. Multivariable analysis demonstrated that the independent predictors of MB-ISR were calcification (HR 2.284, p = 0.016), true-bifurcation (HR 2.331, p = 0.024), insulin-dependent diabetes mellitus (insulin-DM) (HR 2.259, p = 0.048). Furthermore, final proximal postdilatation (FPPD) (HR 0.548, p = 0.077), full LM cover approach (FCA) (HR 0.605, p = 0.093) and greater MLD (HR 0.611, p = 0.062) had a tendency to reduce MB-ISR. Furthermore, the occurrence of MB-ISR within 1-year was associated with cardiac-death (HR 2.734, p = 0.017). CONCLUSIONS: The patients with MB-ISR had more comorbidities and complex lesions, resulting in higher risk of cardiac mortality as compared to the patients without MB-ISR. Presence of calcification, true-bifurcation and insulin-DM were associated with MB-ISR following UDLM intervention, while FCA, FPPD, and greater MLD seemed to be associated with the low occurrence of MB-ISR.
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