Fabrizio D'Ascenzo1, Mario Iannaccone2, Francesca Giordana2, Alaide Chieffo3, Stephen O Connor4, L Christian Napp5, SujaySubash Chandran6, José María de la Torre Hernández7, Shao-Liang Chen2, Ferdinando Varbella8, Pierluigi Omedè2, Salma Taha2, Emanuele Meliga9, Hiroyoshi Kawamoto3, Antonio Montefusco2, Mervyn Chong6, Philippe Garot4, Lin Sin2, Valeria Gasparetto10, Mohamed Abdirashid2, Enrico Cerrato11, Giuseppe Biondi-Zoccai12, Fiorenzo Gaita2, Javier Escaned13, David Hiddick Smith6, Thierry Lefèvre4, Antonio Colombo3, Imad Sheiban14, Claudio Moretti15. 1. Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy. Electronic address: fabrizio.dascenzo@gmail.com. 2. Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy. 3. Scientific Institute S. Raffaele, Milan, Italy. 4. Department of Cardiology, Institut Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France. 5. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. 6. Division of Cardiology, Brighton, United Kingdom. 7. Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain. 8. Cardiology Department, Ospedale degli Infermi, Rivoli, TO, Italy. 9. Divisione di Cardiologia, Ospedale Mauriziano, Italy. 10. Division di Cardiologia, Ospedale Pederzoli, Italy. 11. Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain; Cardiology Department, Ospedale degli Infermi, Rivoli, TO, Italy. 12. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy. 13. Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain. 14. Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy; Division di Cardiologia, Ospedale Pederzoli, Italy. 15. Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy; Division of Cardiology, Brighton, United Kingdom.
Abstract
AIMS: There is uncertainty on which stenting approach confers the best long-term outlook for unprotected left main (ULM) bifurcation disease. METHODS AND RESULTS: This is a non-randomized, retrospective study including all consecutive patients with 50% stenosis of the left main involving at least 1 of the arteries stemming from the left main treated with drug-eluting stents (DES) in 9 European centers between 2002 and 2004. Patients were divided into two groups: those treated with provisional stentings vs. those treated with two stent strategy. The outcomes of interest were 10-year rates of target lesion revascularization (TLR), major adverse cardiac events (MACE), and their components (cardiovascular death, myocardial infarction [MI], or repeat revascularization), along with stent thrombosis (ST). A total of 285 patients were included, 178 (62.5%) in the provisional stenting group and 87 (37.5%) in the two stent group. After 10 years, no differences in TLR were found at unadjusted analysis (19% vs 25%, p>0.05) nor after propensity score matching (25% vs 28%, p>0.05). Similar rates of MACE (60% vs 66%, p>0.05), death (34% vs 43%, p>0.05), MI (9% vs 14%, p>0.05) and ST were also disclosed at propensity-based analysis. CONCLUSION: Even after 10 year follow-up, patients treated with provisional stenting on left main showed comparable rates of target lesion revascularization compared to two stent strategy.
AIMS: There is uncertainty on which stenting approach confers the best long-term outlook for unprotected left main (ULM) bifurcation disease. METHODS AND RESULTS: This is a non-randomized, retrospective study including all consecutive patients with 50% stenosis of the left main involving at least 1 of the arteries stemming from the left main treated with drug-eluting stents (DES) in 9 European centers between 2002 and 2004. Patients were divided into two groups: those treated with provisional stentings vs. those treated with two stent strategy. The outcomes of interest were 10-year rates of target lesion revascularization (TLR), major adverse cardiac events (MACE), and their components (cardiovascular death, myocardial infarction [MI], or repeat revascularization), along with stent thrombosis (ST). A total of 285 patients were included, 178 (62.5%) in the provisional stenting group and 87 (37.5%) in the two stent group. After 10 years, no differences in TLR were found at unadjusted analysis (19% vs 25%, p>0.05) nor after propensity score matching (25% vs 28%, p>0.05). Similar rates of MACE (60% vs 66%, p>0.05), death (34% vs 43%, p>0.05), MI (9% vs 14%, p>0.05) and ST were also disclosed at propensity-based analysis. CONCLUSION: Even after 10 year follow-up, patients treated with provisional stenting on left main showed comparable rates of target lesion revascularization compared to two stent strategy.
Authors: Fabrizio D'Ascenzo; Ovidio De Filippo; Edoardo Elia; Mattia Paolo Doronzo; Pierluigi Omedè; Antonio Montefusco; Mauro Pennone; Stefano Salizzoni; Federico Conrotto; Guglielmo Gallone; Filippo Angelini; Luca Franchin; Francesco Bruno; Massimo Boffini; Mario Gaudino; Mauro Rinaldi; Gaetano Maria De Ferrari Journal: Eur Heart J Qual Care Clin Outcomes Date: 2021-09-16
Authors: Gianluca Rigatelli; Fabio Dell'Avvocata; Marco Zuin; Sara Giatti; Khanh Duong; Trung Pham; Nguyen Si Tuan; Dobrin Vassiliev; Ramesh Daggubati; Thach Nguyen Journal: J Transl Int Med Date: 2017-12-29