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Takagi K, Ielasi A, Chieffo A, Basavarajaiah S, Latib A, Montorfano M, Carlino M, Mizuno H, Hasegawa T, Godino C, Figini F, Shannon J, Rezq A, Ferrarello S, Bernelli C, Naganuma T, Fujino Y, Nakamura S, Colombo A. Impact of Residual Chronic Total Occlusion of Right Coronary Artery on the Long-term Outcome in Patients Treated for Unprotected Left Main Disease. Circ Cardiovasc Interv 2013; 6:154-60. [DOI: 10.1161/circinterventions.112.000079] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background—
The presence of chronic total occlusion of the right coronary artery (CTO-RCA) in patients undergoing percutaneous interventions for unprotected left main (ULM) disease may affect the prognosis. In this study, we evaluated the immediate results and follow-up of patients with ULM-percutaneous interventions and with or without associated CTO-RCA.
Methods and Results—
Between March 2002 and December 2008, a total of 568 consecutive patients with ULM stenosis treated with drug-eluting stent were included in this analysis. The mean EuroScore and SYNTAX scores were 4.05±2.62 and 28.12±10.82, respectively. Of these, 522 had ULM lesions without residual CTO-RCA (493 ULM without CTO-RCA+29 ULM with treated CTO-RCA), and 46 patients had residual CTO-RCA. At 1466 days (interquartile range, 1150–1917) follow-up, the cardiac-death occurred in 41 patients (7.2%). Cardiac-death was more frequently observed in patients with ULM and residual CTO-RCA as compared with those without residual CTO-RCA (adjusted hazard ratios, 2.163 [95% confidence interval, 1.018–4.597];
P
=0.045). However, target lesion revascularization occurred less frequently in patients with residual CTO-RCA (adjusted hazard ratios, 0.321 [95% confidence interval, 0.13–0.794];
P
=0.014), resulting in the similar major adverse cardiovascular events rates between the 2 groups. When we analyzed patients with concomitant ULM and CTO-RCA, cardiac-death was significantly higher in patients with residual as compared with treated CTO-RCA (log-rank
P
=0.01) despite no difference in baseline characteristics.
Conclusions—
Cardiac-death occurred more frequently in patients with residual CTO-RCA as compared with those without residual CTO-RCA. These findings suggest that recanalization of CTO-RCA has significant impact on the long-term cardiac-mortality in patients undergoing ULM-percutaneous interventions probably by offering reserve coronary circulation, if in-stent restenosis were to occur in the treated left main.
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Affiliation(s)
- Kensuke Takagi
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Alfonso Ielasi
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Alaide Chieffo
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Sandeep Basavarajaiah
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Azeem Latib
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Matteo Montorfano
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Mauro Carlino
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Hiroyuki Mizuno
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Tasuku Hasegawa
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Cosmo Godino
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Filippo Figini
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Joanne Shannon
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Ahmed Rezq
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Santo Ferrarello
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Chiara Bernelli
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Toru Naganuma
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Yusuke Fujino
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Sunao Nakamura
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
| | - Antonio Colombo
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (K.T., A.C., S.B., A.L., M.M., M.C., H.M., T.H., C.G., F.F., J.S., A.R., S.F., C.B., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (K.T., S.B., A.L., T.H., C.G., F.F., J.S., A.R., A.C.); and Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.N.)
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