JACC. Cardiovascular interventions · 2013
Long-term clinical outcomes after percutaneous coronary intervention for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery: 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.
Сравнительное исследованиеСтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Naganuma Toru, Chieffo Alaide, Meliga Emanuele, Capodanno Davide, Park Seung-Jung, Onuma Yoshinobu, Valgimigli Marco, Jegere Sanda, Makkar Raj R, Palacios Igor F, Costopoulos Charis, Kim Young-Hak, Buszman Piotr P, Chakravarty Tarun, Sheiban Imad, Mehran Roxana, Naber Christoph, Margey Ronan, Agnihotri Arvind, Marra Sebastiano, Capranzano Piera, Leon Martin B, Moses Jeffrey W, Fajadet Jean, Lefevre Thierry, Morice Marie-Claude, Erglis Andrejs, Tamburino Corrado, Alfieri Ottavio, Serruys Patrick W, Colombo Antonio
Аннотация
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.
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.
Предметные рубрики MeSH
AgedChi-Square DistributionCoronary Artery BypassCoronary Artery DiseaseCoronary StenosisDrug-Eluting StentsEuropeFemaleHumansIncidenceKaplan-Meier EstimateLogistic ModelsMaleMiddle AgedMultivariate AnalysisMyocardial InfarctionPercutaneous Coronary InterventionPropensity ScoreRegistriesRepublic of KoreaRetrospective StudiesRisk FactorsTime FactorsTreatment OutcomeUnited States