TY - JOUR
T1 - Long-term clinical outcomes after percutaneous coronary intervention for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery
T2 - The DELTA Registry (Drug-Eluting Stent for Left Main Coronary Artery Disease): A multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment
AU - Naganuma, Toru
AU - Chieffo, Alaide
AU - Meliga, Emanuele
AU - Capodanno, Davide
AU - Park, Seung Jung
AU - Onuma, Yoshinobu
AU - Valgimigli, Marco
AU - Jegere, Sanda
AU - Makkar, Raj R.
AU - Palacios, Igor F.
AU - Costopoulos, Charis
AU - Kim, Young Hak
AU - Buszman, Piotr P.
AU - Chakravarty, Tarun
AU - Sheiban, Imad
AU - Mehran, Roxana
AU - Naber, Christoph
AU - Margey, Ronan
AU - Agnihotri, Arvind
AU - Marra, Sebastiano
AU - Capranzano, Piera
AU - Leon, Martin B.
AU - Moses, Jeffrey W.
AU - Fajadet, Jean
AU - Lefevre, Thierry
AU - Morice, Marie Claude
AU - Erglis, Andrejs
AU - Tamburino, Corrado
AU - Alfieri, Ottavio
AU - Serruys, Patrick W.
AU - Colombo, Antonio
PY - 2013/12
Y1 - 2013/12
N2 - 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.
AB - 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.
KW - distal bifurcation lesion
KW - drug-eluting stent(s)
KW - ostial/mid-shaft lesion
KW - unprotected left main coronary artery
UR - https://www.scopus.com/pages/publications/84890638934
U2 - 10.1016/j.jcin.2013.08.005
DO - 10.1016/j.jcin.2013.08.005
M3 - Article
C2 - 24355114
AN - SCOPUS:84890638934
SN - 1936-8798
VL - 6
SP - 1242
EP - 1249
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 12
ER -
