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Dores H, Raposo L, Almeida MS, Brito J, Santos PG, Sousa PJ, Gabriel HM, Gonçalves PA, Teles RC, Machado FP, Mendes M. Percutaneous coronary intervention of unprotected left main disease: five-year outcome of a single-center registry. Rev Port Cardiol 2013; 32:997-1004. [PMID: 24287023 DOI: 10.1016/j.repc.2013.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/02/2013] [Accepted: 04/24/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND AIMS Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main coronary artery (ULMCA) lesions. We aimed to evaluate the long-term outcome of patients undergoing ULMCA PCI. METHODS AND RESULTS We retrospectively analyzed 95 consecutive patients (median EuroSCORE I 2.9 [IQR 1.4;6.1]) who underwent ULMCA PCI between 1999 and 2006, included in a single-center prospective registry. The primary outcome was major adverse cardiovascular events (MACE) defined as all-cause death, myocardial infarction (MI) and target lesion revascularization (TLR) at five years. Forty patients (42.1%) were treated in the setting of acute coronary syndrome and 81 patients (85%) had at least one additional significant lesion (SYNTAX score 24.2±11.8). Single ULMCA PCI was performed in 33% (81.1% with drug-eluting stents) and complete functional revascularization was achieved in 79% of the patients. During the observation period, 20 patients died (21.1%), 6 (6.3%) had MI and 11 (11.6%) had TLR (total combined MACE 28.4%). Independent predictors of MACE were previous MI (HR 2.9 95% CI 1.23-6.92; p=0.015), hypertension (HR 5.7 95% CI 1.86-17.47; p=0.002) and the EuroSCORE I (HR 1.1 95% CI 1.03-1.12; p=0.001). Drug-eluting stent implantation was associated with a significantly lower MACE rate, even after propensity score adjustment (AUC=0.84; HR [corrected] 0.1; 95% CI 0.04-0.26; p<0.001). CONCLUSIONS Unprotected left main percutaneous coronary intervention, particularly using drug-eluting stents, can be considered a valid alternative to coronary artery bypass grafting, especially in high-risk surgical patients and with favorable anatomic features.
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Affiliation(s)
- Hélder Dores
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
| | - Luís Raposo
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Manuel Sousa Almeida
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - João Brito
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Pedro Galvão Santos
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Pedro Jerónimo Sousa
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Henrique Mesquita Gabriel
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Pedro Araújo Gonçalves
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Rui Campante Teles
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Francisco Pereira Machado
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Mendes
- Cardiology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Pandya SB, Kim YH, Meyers SN, Davidson CJ, Flaherty JD, Park DW, Mediratta A, Pieper K, Reyes E, Bonow RO, Park SJ, Beohar N. Drug-eluting versus bare-metal stents in unprotected left main coronary artery stenosis a meta-analysis. JACC Cardiovasc Interv 2010; 3:602-11. [PMID: 20630453 DOI: 10.1016/j.jcin.2010.03.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/18/2010] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We undertook a meta-analysis to assess outcomes for drug-eluting stents (DES) and bare-metal stents (BMS) in percutaneous coronary intervention for unprotected left main coronary artery (ULMCA) stenosis. BACKGROUND Uncertainty exists regarding the relative performance of DES versus BMS in percutaneous coronary intervention for unprotected left main coronary stenosis. METHODS Of a total of 838 studies, 44 met inclusion criteria (n = 10,342). The co-primary end points were mortality, myocardial infarction (MI), target vessel/lesion revascularization (TVR/TLR), and major adverse cardiac events (MACE: mortality, MI, TVR/TLR). RESULTS Event rates for DES and BMS were calculated at 6 to 12 months, at 2 years, and at 3 years. Crude event rates at 3 years were mortality (8.8% and 12.7%), MI (4.0% and 3.4%), TVR/TLR (8.0% and 16.4%), and MACE (21.4% and 31.6%). Nine studies were included in a comparative analysis (n = 5,081). At 6 to 12 months the adjusted odds ratio (OR) for DES versus BMS were: mortality 0.94 (95% confidence interval [CI]: 0.06 to 15.48; p = 0.97), MI 0.64 (95% CI: 0.19 to 2.17; p = 0.47), TVR/TLR 0.10 (95% CI: 0.01 to 0.84; p = 0.01), and MACE 0.34 (95% CI: 0.15 to 0.78; p = 0.01). At 2 years, the OR for DES versus BMS were: mortality 0.42 (95% CI: 0.28 to 0.62; p < 0.01), MI 0.16 (95% CI: 0.01 to 3.53; p = 0.13), and MACE 0.31 (95% CI: 0.15 to 0.66; p < 0.01). At 3 years, the OR for DES versus BMS were: mortality 0.70 (95% CI: 0.53 to 0.92; p = 0.01), MI 0.49 (95% CI: 0.26 to 0.92; p = 0.03), TVR/TLR 0.46 (95% CI: 0.30 to 0.69; p < 0.01), and MACE 0.78 (95% CI: 0.57 to 1.07; p = 0.12). CONCLUSIONS Our meta-analysis suggests that DES is associated with favorable outcomes for mortality, MI, TVR/TLR, and MACE as compared to BMS in percutaneous coronary intervention for unprotected left main coronary artery stenosis.
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Affiliation(s)
- Sanjay B Pandya
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A, Mack MJ, Holmes DR, Torracca L, van Es GA, Leadley K, Dawkins KD, Mohr F. Outcomes in Patients With De Novo Left Main Disease Treated With Either Percutaneous Coronary Intervention Using Paclitaxel-Eluting Stents or Coronary Artery Bypass Graft Treatment in the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) Trial. Circulation 2010; 121:2645-53. [PMID: 20530001 DOI: 10.1161/circulationaha.109.899211] [Citation(s) in RCA: 425] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marie-Claude Morice
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Patrick W. Serruys
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - A. Pieter Kappetein
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Ted E. Feldman
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Elisabeth Ståhle
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Antonio Colombo
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Michael J. Mack
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - David R. Holmes
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Lucia Torracca
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Gerrit-Anne van Es
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Katrin Leadley
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Keith D. Dawkins
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
| | - Friedrich Mohr
- From the Institut Hospitalier Jacques Cartier, Massy, France (M.M.); Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, Ill (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C., L.T.); Heart Hospital Baylor Plano, Dallas, Tex (M.J.M.); Mayo Clinic, Rochester, Minn (D.R.H.); Cardialysis, Rotterdam, the Netherlands (G.v.E.); Boston Scientific Corp, Natick, Mass (K.L., K.D
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