BACKGROUND: Unprotected distal left main trifurcation (ULMT) lesion represents a challenge for interventional cardiologists with the potential for peri-procedural complications and adverse events at follow-up especially when the main branch and the side branches are concomitantly diseased.METHODS: A retrospective cohort analysis was performed on consecutive patients with ULMT stenosis who electively underwent percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation in order to assess the technical feasibility and long-term outcomes according to the disease distribution in the trifurcation branches (true vs. non-true ULMT). Primary endpoint of the study was a composite of major adverse cardiovascular events (MACE) defined as cardiac-death, myocardial infarction (MI), and target lesion revascularization (TLR) during follow-up.RESULTS: Eighty-four patients underwent PCI with DES for ULMT disease during the study period (40 true trifurcation and 44 non-true trifurcation). Angiographic and procedural success were obtained in 94% and 92.8% of cases. At 3-years follow-up, the occurrence of MACE was significantly higher in patients with true ULMT than in those with non-true ULMT (HR 2.801 [confidence interval; CI 1.164-7.896], P = 0.025) due to a higher TLR rate (HR 3.032 [CI 1.164-7.896], P = 0.023). No episodes of late and very late definite/probable stent thrombosis (ST) occurred. On multivariable analysis, a true-ULMT lesion was the only independent predictor of MACE (HR 2.344 [C.I. 1.006-5.461], P = 0.049).CONCLUSIONS: PCI with DES for ULMT stenosis is feasible with a high procedural success rate and no definite/probable ST reported at follow-up. A true trifurcation lesion is associated with enhanced risk of MACE mainly driven by TLR.

Long-term clinical outcomes following drug-eluting stent implantation for unprotected distal trifurcation left main disease: the Milan-New Tokyo (MITO) registry / Ielasi, Alfonso; Takagi, Kensuke; Latib, Azeem; Basavarajaiah, Sandeep; Figini, Filippo; Carlino, Mauro; Montorfano, M; Chieffo, Alaide; Nakamura, Sunao; Colombo, Antonio. - In: CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. - ISSN 1522-726X. - 83:(2014), pp. 530-538. [10.1002/ccd.25174]

Long-term clinical outcomes following drug-eluting stent implantation for unprotected distal trifurcation left main disease: the Milan-New Tokyo (MITO) registry

Montorfano M;Chieffo Alaide;
2014-01-01

Abstract

BACKGROUND: Unprotected distal left main trifurcation (ULMT) lesion represents a challenge for interventional cardiologists with the potential for peri-procedural complications and adverse events at follow-up especially when the main branch and the side branches are concomitantly diseased.METHODS: A retrospective cohort analysis was performed on consecutive patients with ULMT stenosis who electively underwent percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation in order to assess the technical feasibility and long-term outcomes according to the disease distribution in the trifurcation branches (true vs. non-true ULMT). Primary endpoint of the study was a composite of major adverse cardiovascular events (MACE) defined as cardiac-death, myocardial infarction (MI), and target lesion revascularization (TLR) during follow-up.RESULTS: Eighty-four patients underwent PCI with DES for ULMT disease during the study period (40 true trifurcation and 44 non-true trifurcation). Angiographic and procedural success were obtained in 94% and 92.8% of cases. At 3-years follow-up, the occurrence of MACE was significantly higher in patients with true ULMT than in those with non-true ULMT (HR 2.801 [confidence interval; CI 1.164-7.896], P = 0.025) due to a higher TLR rate (HR 3.032 [CI 1.164-7.896], P = 0.023). No episodes of late and very late definite/probable stent thrombosis (ST) occurred. On multivariable analysis, a true-ULMT lesion was the only independent predictor of MACE (HR 2.344 [C.I. 1.006-5.461], P = 0.049).CONCLUSIONS: PCI with DES for ULMT stenosis is feasible with a high procedural success rate and no definite/probable ST reported at follow-up. A true trifurcation lesion is associated with enhanced risk of MACE mainly driven by TLR.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/144636
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