BACKGROUND: There are only little data available on the comparison of clinical outcomes between a 1-stent strategy (1-SS) and a 2-stent strategy (2-SS) for percutaneous coronary intervention in unprotected distal left main disease.METHODS AND RESULTS: Between April 2005 and August 2011, we recruited 937 consecutive unprotected distal left main patients treated with drug-eluting stents (1-SS, 608 patients; 2-SS, 329 patients). Major adverse cardiovascular events were defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR) during the median follow-up period of 1592 days. Furthermore, the individual components of major adverse cardiovascular events, cardiac death, and stent thrombosis were evaluated. More complex lesions were seen with 2-SS than with 1-SS. Cardiac death occurred more frequently with 1-SS than with 2-SS (propensity score-adjusted hazard ratio, 0.52; 95% confidence interval, 0.29-0.64; P=0.03), whereas TLR occurred more frequently with 2-SS than with 1-SS (propensity score-adjusted hazard ratio, 1.59; 95% confidence interval, 1.15-2.20; P=0.005). TLR was mainly driven by revascularizations after restenosis at the ostial left circumflex artery (propensity score-adjusted hazard ratio, 1.94; 95% confidence interval, 1.33-2.82; P=0.001). However, there were no differences in major adverse cardiovascular events, all-cause death, stent thrombosis, and myocardial infarction. Of the 139 pairs that were propensity score matched, only TLRs were significantly higher in the 2-SS group (hazard ratio, 1.59; 95% confidence interval, 1.00-2.53; P=0.05).CONCLUSIONS: The difference between 1-SS and 2-SS in percutaneous coronary intervention for unprotected distal left main disease may be summarized by the high incidence of TLR, mainly because of restenosis at the ostial left circumflex artery in the 2-SS group.

Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease: The Milan and New-Tokyo Registry / Takagi, Kensuke; Naganuma, Toru; Chieffo, Alaide; Fujino, Yusuke; Latib, Azeem; Tahara, Satoko; Ishiguro, Hisaaki; Montorfano, M; Carlino, Mauro; Kawamoto, Hiroyoshi; Kurita, Naoyuki; Hozawa, Koji; Nakamura, Shotaro; Nakamura, Sunao; Colombo, Antonio. - In: CIRCULATION. CARDIOVASCULAR INTERVENTIONS. - ISSN 1941-7632. - 9:11(2016). [10.1161/CIRCINTERVENTIONS.116.003359]

Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease: The Milan and New-Tokyo Registry

Chieffo Alaide;Montorfano M;
2016-01-01

Abstract

BACKGROUND: There are only little data available on the comparison of clinical outcomes between a 1-stent strategy (1-SS) and a 2-stent strategy (2-SS) for percutaneous coronary intervention in unprotected distal left main disease.METHODS AND RESULTS: Between April 2005 and August 2011, we recruited 937 consecutive unprotected distal left main patients treated with drug-eluting stents (1-SS, 608 patients; 2-SS, 329 patients). Major adverse cardiovascular events were defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR) during the median follow-up period of 1592 days. Furthermore, the individual components of major adverse cardiovascular events, cardiac death, and stent thrombosis were evaluated. More complex lesions were seen with 2-SS than with 1-SS. Cardiac death occurred more frequently with 1-SS than with 2-SS (propensity score-adjusted hazard ratio, 0.52; 95% confidence interval, 0.29-0.64; P=0.03), whereas TLR occurred more frequently with 2-SS than with 1-SS (propensity score-adjusted hazard ratio, 1.59; 95% confidence interval, 1.15-2.20; P=0.005). TLR was mainly driven by revascularizations after restenosis at the ostial left circumflex artery (propensity score-adjusted hazard ratio, 1.94; 95% confidence interval, 1.33-2.82; P=0.001). However, there were no differences in major adverse cardiovascular events, all-cause death, stent thrombosis, and myocardial infarction. Of the 139 pairs that were propensity score matched, only TLRs were significantly higher in the 2-SS group (hazard ratio, 1.59; 95% confidence interval, 1.00-2.53; P=0.05).CONCLUSIONS: The difference between 1-SS and 2-SS in percutaneous coronary intervention for unprotected distal left main disease may be summarized by the high incidence of TLR, mainly because of restenosis at the ostial left circumflex artery in the 2-SS group.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/144665
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