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.

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: Toru Naganuma, Alaide Chieffo, Emanuele Meliga, Davide Capodanno, Seung-Jung Park, Yoshinobu Onuma, Marco Valgimigli, Sanda Jegere, Raj R Makkar, Igor F Palacios, Charis Costopoulos, Young-Hak Kim, Piotr P Buszman, Tarun Chakravarty, Imad Sheiban, Roxana Mehran, Christoph Naber, Ronan Margey, Arvind Agnihotri, Sebastiano Marra, Piera Capranzano, Martin B Leon, Jeffrey W Moses, Jean Fajadet, Thierry Lefevre, Marie-Claude Morice, Andrejs Erglis, Corrado Tamburino, Ottavio Alfieri, Patrick W Serruys, Antonio Colombo
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 6 Issue 12 Pg. 1242-9 (Dec 2013) ISSN: 1876-7605 [Electronic] United States
• PMID: 24355114 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Chi-Square Distribution
• Coronary Artery Bypass (adverse effects, mortality)
• Coronary Artery Disease (diagnosis, mortality, surgery, therapy)
• Coronary Stenosis (diagnosis, mortality, surgery, therapy)
• Drug-Eluting Stents
• Europe (epidemiology)
• Female
• Humans
• Incidence
• Kaplan-Meier Estimate
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (mortality)
• Percutaneous Coronary Intervention (adverse effects, instrumentation, mortality)
• Propensity Score
• Registries
• Republic of Korea (epidemiology)
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• United States (epidemiology)