Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease: The Milan and New-Tokyo Registry.
نویسندگان
چکیده
BACKGROUND There are only little data available on the comparison of clinical outcomes between a 1-stent strategy (1-SS) and a 2-stent strategy (2-SS) for percutaneous coronary intervention in unprotected distal left main disease. METHODS AND RESULTS Between April 2005 and August 2011, we recruited 937 consecutive unprotected distal left main patients treated with drug-eluting stents (1-SS, 608 patients; 2-SS, 329 patients). Major adverse cardiovascular events were defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR) during the median follow-up period of 1592 days. Furthermore, the individual components of major adverse cardiovascular events, cardiac death, and stent thrombosis were evaluated. More complex lesions were seen with 2-SS than with 1-SS. Cardiac death occurred more frequently with 1-SS than with 2-SS (propensity score-adjusted hazard ratio, 0.52; 95% confidence interval, 0.29-0.64; P=0.03), whereas TLR occurred more frequently with 2-SS than with 1-SS (propensity score-adjusted hazard ratio, 1.59; 95% confidence interval, 1.15-2.20; P=0.005). TLR was mainly driven by revascularizations after restenosis at the ostial left circumflex artery (propensity score-adjusted hazard ratio, 1.94; 95% confidence interval, 1.33-2.82; P=0.001). However, there were no differences in major adverse cardiovascular events, all-cause death, stent thrombosis, and myocardial infarction. Of the 139 pairs that were propensity score matched, only TLRs were significantly higher in the 2-SS group (hazard ratio, 1.59; 95% confidence interval, 1.00-2.53; P=0.05). CONCLUSIONS The difference between 1-SS and 2-SS in percutaneous coronary intervention for unprotected distal left main disease may be summarized by the high incidence of TLR, mainly because of restenosis at the ostial left circumflex artery in the 2-SS group.
منابع مشابه
Acute and Long Term Outcomes of Coronary Intervention in Unprotected Left Main Lesions
Introduction : Significant left main coronary artery stenosis jeopardizes the entire myocardium of the left ventricle and has the worst prognosis of any form of coronary artery disease. Coronary-artery bypass grafting (CABG) has been considered as the standard therapeutic approach for such patients. There are limited data on the safety and effectiveness of percutaneous coronary intervention (PC...
متن کاملClinical and procedural predictors of suboptimal outcome after the treatment of drug-eluting stent restenosis in the unprotected distal left main stem: the Milan and New-Tokyo (MITO) registry.
BACKGROUND Few data are available regarding the optimal revascularization strategy for unprotected distal left main coronary artery (UDLM) in-stent restenosis (ISR). METHODS AND RESULTS Between April 2002 and December 2008, UDLM-ISR following drug-eluting stent (DES) implantation occurred in 92 of 474 patients (19.4%). Of these, 8 (8.7%) who underwent a coronary artery bypass graft (CABG) wer...
متن کاملVery long-term outcomes following drug-eluting stent implantation for unprotected left main coronary artery stenosis: a single center experience.
INTRODUCTION AND OBJECTIVES Encouraging results at long-term follow-up have been reported from non-randomized registries and randomized trials following percutaneous coronary intervention with drug-eluting stent implantation for unprotected left main stenosis. However, information on very long-term (>5-year) outcomes is limited. The aim of this study was to assess the very long-term outcomes (6...
متن کاملNew-generation drug-eluting stent experience in the percutaneous treatment of unprotected left main coronary artery disease: the NEST registry.
OBJECTIVES To explore the 2-year clinical outcomes in patients with unprotected left main coronary artery (ULMCA) disease treated with overall new drug-eluting stent (DES) options. BACKGROUND Recent available data have shown the feasibility and the safety of new DESs, mainly evaluating the everolimus-eluting stents in the setting of ULMCA disease. METHODS Patients with ULMCA disease undergo...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Circulation. Cardiovascular interventions
دوره 9 11 شماره
صفحات -
تاریخ انتشار 2016