Impact of coronary anatomy and stenting technique on long-term outcome after drug-eluting stent implantation for unprotected left main coronary artery disease

JACC. Cardiovascular Interventions
Klaus TirochISAR-LEFT MAIN Study Investigators

Abstract

This study sought to evaluate the impact of anatomic and procedural variables on the outcome of the unprotected left main coronary artery (uLMCA) itself after drug-eluting stent (DES) implantation. There is a controversial debate regarding when and how to perform percutaneous coronary intervention (PCI) for an uLMCA stenosis. This analysis is based on a randomized study of 607 patients undergoing PCI for uLMCA, randomized 1:1 to receive paclitaxel- or sirolimus-eluting stents. We evaluated the impact of the SYNTAX score, uLMCA anatomy, and stenting technique on in-stent restenosis (ISR), target lesion revascularization (TLR), and the 3-year outcomes. The 3-year cardiac mortality rate was 5.8%; 235 (39%) patients had a true bifurcation lesion (TBL), and the median SYNTAX score was 27. TBL was associated with a higher need for multiple stents (72% vs. 37%, p < 0.001). TBL was a significant predictor of ISR (23% vs. 14%, p = 0.008) and for TLR (18% vs. 9%, p < 0.001). The need for multiple stents was a predictor of ISR (22% vs. 13%, p = 0.005) and for TLR (16% vs. 9%, p = 0.005). Culotte stenting showed better results compared with T-stenting for ISR (21% vs. 56%, p = 0.02) and for TLR (15% vs. 56%, p < 0.001). We observed a signi...Continue Reading

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Citations

Sep 27, 2014·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Jens Flensted LassenYves Louvard
Oct 24, 2014·Expert Review of Cardiovascular Therapy·Chiara Bernelli
Sep 17, 2014·Journal of Interventional Cardiology·D VassilevR J Gil
Mar 15, 2015·Current Problems in Cardiology·Michael Ragosta
Dec 18, 2013·JACC. Cardiovascular Interventions·Marie-Claude Morice
Jul 30, 2016·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Hiroyoshi KawamotoAntonio Colombo
Jan 18, 2018·Journal of Translational Internal Medicine·Gianluca RigatelliThach Nguyen
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Jan 19, 2018·Current Atherosclerosis Reports·Harshith R Avula, Andrew N Rassi
Dec 12, 2018·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Fudong HuLianglong Chen
Feb 29, 2020·Minerva cardioangiologica·Mauro Chiarito, Julinda Mehilli
Mar 13, 2021·European Cardiology·George William HunterDerek Connolly
May 6, 2017·JACC. Cardiovascular Interventions·Tanveer RabShao Liang Chen
Apr 1, 2018·Journal of cardiology·Leslie Marisol Lugo, José Luis Ferreiro

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