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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.
JACC Cardiovasc Interv. 2013 Dec; 6(12):1242-9.JC

Abstract

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.

Authors+Show Affiliations

Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.Interventional Cardiology Unit, A. O. Ordine Mauriziano Umberto I, Turin, Italy.Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.Cardiovascular Institute, University of Ferrara, S. Anna Hospital, Ferrara, Italy.Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; Institute of Cardiology, University of Latvia, Riga, Latvia.Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.Center for Cardiovascular Research and Development of American Heart of Poland, Katowice, Poland.Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy.Mount-Sinai Medical Center, New York, New York.Clinique Pasteur, Toulouse, France.Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy.Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.Clinique Pasteur, Toulouse, France.Institut Hospitalier Jacques Cartier, Générale de Santé, Massy, France.Institut Hospitalier Jacques Cartier, Générale de Santé, Massy, France.Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; Institute of Cardiology, University of Latvia, Riga, Latvia.Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy. Electronic address: colombo.antonio@hsr.it.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

24355114

Citation

Naganuma, Toru, et al. "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." JACC. Cardiovascular Interventions, vol. 6, no. 12, 2013, pp. 1242-9.
Naganuma T, Chieffo A, Meliga E, et al. 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. JACC Cardiovasc Interv. 2013;6(12):1242-9.
Naganuma, T., Chieffo, A., Meliga, E., Capodanno, D., Park, S. J., Onuma, Y., Valgimigli, M., Jegere, S., Makkar, R. R., Palacios, I. F., Costopoulos, C., Kim, Y. H., Buszman, P. P., Chakravarty, T., Sheiban, I., Mehran, R., Naber, C., Margey, R., Agnihotri, A., ... Colombo, A. (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. JACC. Cardiovascular Interventions, 6(12), 1242-9. https://doi.org/10.1016/j.jcin.2013.08.005
Naganuma T, et al. 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. JACC Cardiovasc Interv. 2013;6(12):1242-9. PubMed PMID: 24355114.
* Article titles in AMA citation format should be in sentence-case
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: 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 - 2013/06/16/received PY - 2013/08/08/revised PY - 2013/08/14/accepted PY - 2013/12/21/entrez PY - 2013/12/21/pubmed PY - 2014/8/29/medline KW - CI KW - DES KW - HR KW - IABP KW - LVEF KW - MACE KW - MI KW - PCI KW - TLR KW - TVR KW - ULMCA KW - confidence interval KW - distal bifurcation lesion KW - drug-eluting stent(s) KW - hazard ratio KW - intra-aortic balloon pump KW - left ventricular ejection fraction KW - major adverse cardiac event(s) KW - myocardial infarction KW - ostial/mid-shaft lesion KW - percutaneous coronary intervention KW - target lesion revascularization KW - target vessel revascularization KW - unprotected left main coronary artery SP - 1242 EP - 9 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 6 IS - 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. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/24355114/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(13)01440-4 DB - PRIME DP - Unbound Medicine ER -