Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2014
First generation versus new generation drug-eluting stents for the treatment of ostial/midshaft lesions in unprotected left main coronary artery: the Milan and New-Tokyo (MITO) registry.
Сравнительное исследованиеСтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Naganuma Toru, Chieffo Alaide, Takagi Kensuke, Panoulas Vasileios F, Mitomo Satoru, Sticchi Alessandro, Latib Azeem, Miyazaki Tadashi, Sato Katsumasa, Costopoulos Charis, Fujino Yusuke, Montorfano Matteo, Carlino Mauro, Nakamura Sunao, Colombo Antonio
Аннотация
OBJECTIVES: To compare the clinical outcomes following unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) of ostial/midshaft lesions between first and new generation drug-eluting stents (DES).
BACKGROUND: Clinical outcomes after treatment of ostial/midshaft lesions in ULMCA with first generation DES were favorable. However, to date, data regarding treatment for those lesion subsets with new generation DES have not been reported.
METHODS: A total of 219 patients with ostial/midshaft lesions in ULMCA treated with first (n = 139) or new generation DES (n = 80) were analyzed.
RESULTS: There was a higher prevalence of IVUS use (35.2% vs. 50.0%, P = 0.032) and postdilation (70.5% vs. 93.8%, P < 0.001) with larger maximum balloon diameter (3.81 ± 0.45 vs. 4.08 ± 0.44, P < 0.001) in the new generation DES group. At a median follow-up period of 730 days, there were no significant differences in the propensity-score adjusted analyses, for major adverse cardiac events (MACE) defined as composite endpoint of all-cause death, myocardial infarction, and target vessel revascularization (hazard ratio (HR) [new vs. first generation DES]: 1.22; 95% confidence interval (CI): 0.64-2.31; P = 0.549). Of note, target lesion revascularization rates at 2-years were only 0.9% and 2.7%, for first and new generation DES groups, respectively (P = 0.339). On multivariable analysis, SYNTAX score (HR: 1.06; 95% CI: 1.02-1.11, P = 0.006) and European System for Cardiac Operative Risk Evaluation (HR: 1.14; 95% CI: 1.00-1.31, P = 0.051) were independent predictors for MACE.
CONCLUSIONS: This study suggests that new generation DES for ostial/midshaft lesions in ULMCA are associated with favorable clinical outcomes, similar to those observed with first generation DES.
BACKGROUND: Clinical outcomes after treatment of ostial/midshaft lesions in ULMCA with first generation DES were favorable. However, to date, data regarding treatment for those lesion subsets with new generation DES have not been reported.
METHODS: A total of 219 patients with ostial/midshaft lesions in ULMCA treated with first (n = 139) or new generation DES (n = 80) were analyzed.
RESULTS: There was a higher prevalence of IVUS use (35.2% vs. 50.0%, P = 0.032) and postdilation (70.5% vs. 93.8%, P < 0.001) with larger maximum balloon diameter (3.81 ± 0.45 vs. 4.08 ± 0.44, P < 0.001) in the new generation DES group. At a median follow-up period of 730 days, there were no significant differences in the propensity-score adjusted analyses, for major adverse cardiac events (MACE) defined as composite endpoint of all-cause death, myocardial infarction, and target vessel revascularization (hazard ratio (HR) [new vs. first generation DES]: 1.22; 95% confidence interval (CI): 0.64-2.31; P = 0.549). Of note, target lesion revascularization rates at 2-years were only 0.9% and 2.7%, for first and new generation DES groups, respectively (P = 0.339). On multivariable analysis, SYNTAX score (HR: 1.06; 95% CI: 1.02-1.11, P = 0.006) and European System for Cardiac Operative Risk Evaluation (HR: 1.14; 95% CI: 1.00-1.31, P = 0.051) were independent predictors for MACE.
CONCLUSIONS: This study suggests that new generation DES for ostial/midshaft lesions in ULMCA are associated with favorable clinical outcomes, similar to those observed with first generation DES.
Предметные рубрики MeSH
AgedAged, 80 and overAngioplasty, Balloon, CoronaryCoronary AngiographyCoronary Artery DiseaseDrug-Eluting StentsFemaleHumansItalyJapanKaplan-Meier EstimateLogistic ModelsMaleMiddle AgedMultivariate AnalysisMyocardial InfarctionPropensity ScoreProportional Hazards ModelsProsthesis DesignRegistriesRetrospective StudiesRisk FactorsTime FactorsTreatment OutcomeUltrasonography, Interventional