Toru Naganuma1, Alaide Chieffo1, Emanuele Meliga2, Davide Capodanno3, Seung-Jung Park4, Yoshinobu Onuma5, Marco Valgimigli6, Sanda Jegere7, Raj R Makkar8, Igor F Palacios9, Charis Costopoulos1, Young-Hak Kim4, Piotr P Buszman10, Tarun Chakravarty8, Imad Sheiban11, Roxana Mehran12, Christoph Naber13, Ronan Margey9, Arvind Agnihotri9, Sebastiano Marra11, Piera Capranzano3, Martin B Leon14, Jeffrey W Moses14, Jean Fajadet13, Thierry Lefevre15, Marie-Claude Morice15, Andrejs Erglis7, Corrado Tamburino3, Ottavio Alfieri1, Patrick W Serruys5, Antonio Colombo16. 1. Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy. 2. Interventional Cardiology Unit, A. O. Ordine Mauriziano Umberto I, Turin, Italy. 3. Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy. 4. Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. 5. Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. 6. Cardiovascular Institute, University of Ferrara, S. Anna Hospital, Ferrara, Italy. 7. Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; Institute of Cardiology, University of Latvia, Riga, Latvia. 8. Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. 9. Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. 10. Center for Cardiovascular Research and Development of American Heart of Poland, Katowice, Poland. 11. Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy. 12. Mount-Sinai Medical Center, New York, New York. 13. Clinique Pasteur, Toulouse, France. 14. Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York. 15. Institut Hospitalier Jacques Cartier, Générale de Santé, Massy, France. 16. Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy. Electronic address: colombo.antonio@hsr.it.
Abstract
OBJECTIVES: The aim of this study was to compare, in a large all-comer registry, the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery (ULMCA) stenosis. BACKGROUND: Limited data are available regarding clinical outcomes following DES implantation at the different ULMCA sites. METHODS: Patients with ULMCA stenosis treated by PCI with DES were analyzed in this multinational registry. RESULTS: A total of 1,612 patients were included: 482 were treated for ostial/mid-shaft lesions versus 1,130 for distal bifurcation lesions. At a median follow-up period of 1,250 (interquartile range: 987 to 1,564) days, PCI for distal bifurcation lesions was associated with a higher incidence of major adverse cardiac events (propensity-score adjusted hazard ratio [HR]: 1.48, 95% confidence interval [CI]: 1.16 to 1.89; p = 0.001), largely because of the higher target vessel revascularization rate observed in this group as compared to the ostial/mid-shaft lesions group (propensity-score adjusted HR: 1.68, 95% CI: 1.19 to 2.38; p = 0.003). These results were sustained following propensity-score matched analysis. With regard to all-cause death and the composite endpoint of all-cause death and myocardial infarction, propensity-score adjusted analysis suggested a trend toward higher rates of these in the distal ULMCA PCI group, although this was not observed in the propensity-score matched analysis. CONCLUSIONS: This study demonstrates that PCI for ostial/mid-shaft lesions is associated with better clinical outcomes than are distal bifurcation lesions in ULMCA, largely because there is a lower need for repeat revascularization in ostial/mid-shaft lesions.
OBJECTIVES: The aim of this study was to compare, in a large all-comer registry, the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery (ULMCA) stenosis. BACKGROUND: Limited data are available regarding clinical outcomes following DES implantation at the different ULMCA sites. METHODS:Patients with ULMCA stenosis treated by PCI with DES were analyzed in this multinational registry. RESULTS: A total of 1,612 patients were included: 482 were treated for ostial/mid-shaft lesions versus 1,130 for distal bifurcation lesions. At a median follow-up period of 1,250 (interquartile range: 987 to 1,564) days, PCI for distal bifurcation lesions was associated with a higher incidence of major adverse cardiac events (propensity-score adjusted hazard ratio [HR]: 1.48, 95% confidence interval [CI]: 1.16 to 1.89; p = 0.001), largely because of the higher target vessel revascularization rate observed in this group as compared to the ostial/mid-shaft lesions group (propensity-score adjusted HR: 1.68, 95% CI: 1.19 to 2.38; p = 0.003). These results were sustained following propensity-score matched analysis. With regard to all-cause death and the composite endpoint of all-cause death and myocardial infarction, propensity-score adjusted analysis suggested a trend toward higher rates of these in the distal ULMCA PCI group, although this was not observed in the propensity-score matched analysis. CONCLUSIONS: This study demonstrates that PCI for ostial/mid-shaft lesions is associated with better clinical outcomes than are distal bifurcation lesions in ULMCA, largely because there is a lower need for repeat revascularization in ostial/mid-shaft lesions.
Authors: Jacopo Burrello; Guglielmo Gallone; Alessio Burrello; Daniele Jahier Pagliari; Eline H Ploumen; Mario Iannaccone; Leonardo De Luca; Paolo Zocca; Giuseppe Patti; Enrico Cerrato; Wojciech Wojakowski; Giuseppe Venuti; Ovidio De Filippo; Alessio Mattesini; Nicola Ryan; Gérard Helft; Saverio Muscoli; Jing Kan; Imad Sheiban; Radoslaw Parma; Daniela Trabattoni; Massimo Giammaria; Alessandra Truffa; Francesco Piroli; Yoichi Imori; Bernardo Cortese; Pierluigi Omedè; Federico Conrotto; Shao-Liang Chen; Javier Escaned; Rosaly A Buiten; Clemens Von Birgelen; Paolo Mulatero; Gaetano Maria De Ferrari; Silvia Monticone; Fabrizio D'Ascenzo Journal: J Pers Med Date: 2022-06-17