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Elsheikh AN, Elsaeid A, Sharafeldin S, Elshedoudy S, ElGendy E. Early effect of different bifurcation techniques on left ventricular mechanics in elective percutaneous coronary intervention. Egypt Heart J 2024; 76:81. [PMID: 38955907 PMCID: PMC11219646 DOI: 10.1186/s43044-024-00502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Bifurcation lesions are prevalent amongst patients with symptomatic coronary artery disease subjected to percutaneous coronary intervention (PCI). Recent consensus commends a conservative (provisional) approach when managing the side branch. Here, the aim was to explore the immediate impact of different bifurcation techniques (one stent and two stent strategies) on left ventricular LV) myocardial functions using speckle tracking echocardiography in patients subjected to elective PCI. Sixty two consecutive patients diagnosed with coronary bifurcation lesion (CBL) were enrolled. Patients were categorized into: one-stent strategy (Provisional group, n = 44) and a two-stent strategy (TAP, DK crush, or Culotte technique, n = 18), based on the coronary bifurcation site, angle, side branch diameter and Medina classification. LVEF%, regional and global longitudinal strain (GLS), and E/E' were measured before and within 24 h post PCI. RESULTS In both provisional and 2- stent technique, the mitral inflow velocities and mitral annular velocities showed improvement with significant reduction in E/e' (P < 0.03 and P < 0.001) respectively while LVEF% did not change. There were no significant changes in any other echo parameters post PCI. In provisional group, there were significant improvements in LAD (P < 0.001), RCA (P < 0.01) territories and GLS (P < 0.01). Δ LAD was expressively higher (34.5%) compared with Δ LCX (9.6%) and ΔRCA (25.4%), P < 0.001, P < 0.01 respectively. In the 2-stent technique group, there were significant improvements in peak longitudinal strain of LAD territory (P < 0.01), RCA territory (P < 0.01) and GLS (P < 0.01) respectively. Δ LAD territory was significantly higher in provisional group in comparison with the 2- stent technique group. Δ GLS was correlated inversely to Gensini score in provisional group and to the number of vessel diseased in 2-stent technique group. CONCLUSION PCI of the bifurcation lesion positively impact myocardial function. Both bifurcation techniques improve LV mechanical properties using 2D strain imaging while LV EF% remains unchanged.
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Affiliation(s)
- Amr Nasser Elsheikh
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt.
| | - Ayman Elsaeid
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
| | - Samia Sharafeldin
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
| | - Sahar Elshedoudy
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
| | - Ehab ElGendy
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
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2
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Gaudino M, Sandner S, An KR, Dimagli A, Di Franco A, Audisio K, Harik L, Perezgrovas-Olaria R, Soletti G, Fremes SE, Hare DL, Kulik A, Lamy A, Peper J, Ruel M, Ten Berg JM, Willemsen LM, Zhao Q, Wojdyla DM, Bhatt DL, Alexander JH, Redfors B. Graft Failure After Coronary Artery Bypass Grafting and Its Association With Patient Characteristics and Clinical Events: A Pooled Individual Patient Data Analysis of Clinical Trials With Imaging Follow-Up. Circulation 2023; 148:1305-1315. [PMID: 37417248 DOI: 10.1161/circulationaha.123.064090] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/14/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Graft patency is the postulated mechanism for the benefits of coronary artery bypass grafting (CABG). However, systematic graft imaging assessment after CABG is rare, and there is a lack of contemporary data on the factors associated with graft failure and on the association between graft failure and clinical events after CABG. METHODS We pooled individual patient data from randomized clinical trials with systematic CABG graft imaging to assess the incidence of graft failure and its association with clinical risk factors. The primary outcome was the composite of myocardial infarction or repeat revascularization occurring after CABG and before imaging. A 2-stage meta-analytic approach was used to evaluate the association between graft failure and the primary outcome. We also assessed the association between graft failure and myocardial infarction, repeat revascularization, or all-cause death occurring after imaging. RESULTS Seven trials were included comprising 4413 patients (mean age, 64.4±9.1 years; 777 [17.6%] women; 3636 [82.4%] men) and 13 163 grafts (8740 saphenous vein grafts and 4423 arterial grafts). The median time to imaging was 1.02 years (interquartile range [IQR], 1.00-1.03). Graft failure occurred in 1487 (33.7%) patients and in 2190 (16.6%) grafts. Age (adjusted odds ratio [aOR], 1.08 [per 10-year increment] [95% CI, 1.01-1.15]; P=0.03), female sex (aOR, 1.27 [95% CI, 1.08-1.50]; P=0.004), and smoking (aOR, 1.20 [95% CI, 1.04-1.38]; P=0.01) were independently associated with graft failure, whereas statins were associated with a protective effect (aOR, 0.74 [95% CI, 0.63-0.88]; P<0.001). Graft failure was associated with an increased risk of myocardial infarction or repeat revascularization occurring between CABG and imaging assessment (8.0% in patients with graft failure versus 1.7% in patients without graft failure; aOR, 3.98 [95% CI, 3.54-4.47]; P<0.001). Graft failure was also associated with an increased risk of myocardial infarction or repeat revascularization occurring after imaging (7.8% versus 2.0%; aOR, 2.59 [95% CI, 1.86-3.62]; P<0.001). All-cause death after imaging occurred more frequently in patients with graft failure compared with patients without graft failure (11.0% versus 2.1%; aOR, 2.79 [95% CI, 2.01-3.89]; P<0.001). CONCLUSIONS In contemporary practice, graft failure remains common among patients undergoing CABG and is strongly associated with adverse cardiac events.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.)
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Austria (S.S.)
| | - Kevin R An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.)
- Division of Cardiac Surgery (K.R.A.), University of Toronto, Canada
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.)
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.)
| | - Katia Audisio
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.)
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.)
| | - Roberto Perezgrovas-Olaria
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.)
| | - Giovanni Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.)
| | - Stephen E Fremes
- Department of Cardiac Surgery, Schulich Heart Centre Sunnybrook Health Sciences Centre (S.E.F.), University of Toronto, Canada
| | - David L Hare
- Department of Cardiology, Austin Health, University of Melbourne, Australia (D.L.H.)
| | - Alexander Kulik
- Division of Cardiac Surgery, Boca Raton Regional Hospital and Florida Atlantic Hospital (A.K.)
| | - Andre Lamy
- Department of Surgery, McMaster University, Hamilton, Canada (A.L.)
| | - Joyce Peper
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands (J.P., J.M.t.B., L.M.W.)
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Canada (M.R.)
| | - Jurrien M Ten Berg
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands (J.P., J.M.t.B., L.M.W.)
| | - Laura M Willemsen
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands (J.P., J.M.t.B., L.M.W.)
| | - Qiang Zhao
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (Q.Z.)
| | - Daniel M Wojdyla
- Duke Clinical Research Institute (D.M.W.), Duke University Medical Center, Durham, NC
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (D.L.B.)
| | - John H Alexander
- Division of Cardiology, Department of Medicine (J.H.A.), Duke University Medical Center, Durham, NC
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.)
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Dimagli A, Soletti G, Harik L, Perezgrovas Olaria R, Cancelli G, An KR, Alzghari T, Mack C, Gaudino M. Angiographic Outcomes for Arterial and Venous Conduits Used in CABG. J Clin Med 2023; 12:2022. [PMID: 36902809 PMCID: PMC10004690 DOI: 10.3390/jcm12052022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Coronary artery bypass grafting is the most commonly performed cardiac surgical procedure. Conduit selection is crucial to achieving early optimal outcomes, with graft patency being likely the main driver to long-term survival. We present a review of current evidence on the patency of arterial and venous bypass conduits and of differences in angiographic outcomes.
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Affiliation(s)
- Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Giovanni Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | | | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Kevin R. An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Talal Alzghari
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Charles Mack
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
- Department of Cardiothoracic Surgery, New York Presbyterian Queens Hospital, Queens, New York, NY 11355, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
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4
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Seco M, Paterson HS, Gaudino M, Vallely MP. Selecting the optimal treatment for left main coronary disease: The importance of identifying subgroups of patients. J Card Surg 2022; 37:4190-4195. [PMID: 36168863 DOI: 10.1111/jocs.16565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 01/06/2023]
Abstract
Randomized trials of stenting versus surgery for patients with unprotected left main (LM) coronary stenosis have largely shown similar survival between the two interventions. However, patients with LM stenosis represent a heterogeneous group in which subgroups likely to benefit from one therapy more than another are difficult to identify. Increasing coronary disease burden is the most accepted subgrouping for identifying optimal therapy but this can be defined in more detail allowing greater discrimination. Competitive flow reduces bypass graft patency in patients with isolated LM stenosis and complex bifurcation stenoses reduce the effectiveness of coronary stenting. The evidence for LM stenosis subgroupings is presented.
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Affiliation(s)
- Michael Seco
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Hugh S Paterson
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Michael P Vallely
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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5
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Davierwala PM, Gao C, Thuijs DJFM, Wang R, Hara H, Ono M, Noack T, Garg S, O'leary N, Milojevic M, Kappetein AP, Morice MC, Mack MJ, van Geuns RJ, Holmes DR, Gaudino M, Taggart DP, Onuma Y, Mohr FW, Serruys PW. Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease. Eur Heart J 2021; 43:1334-1344. [PMID: 34405875 PMCID: PMC8970984 DOI: 10.1093/eurheartj/ehab537] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/27/2021] [Accepted: 08/01/2021] [Indexed: 11/12/2022] Open
Abstract
AIM The aim of this study was to compare long-term all-cause mortality between patients receiving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using multiple (MAG) or single arterial grafting (SAG). METHODS AND RESULTS The current study is a post hoc analysis of the SYNTAX Extended Survival Study, which compared PCI with CABG in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD) and evaluated survival with ≥10 years of follow-up. The primary endpoint was all-cause mortality at maximum follow-up (median 11.9 years) assessed in the as-treated population. Of the 1743 patients, 901 (51.7%) underwent PCI, 532 (30.5%) received SAG, and 310 (17.8%) had MAG. At maximum follow-up, all-cause death occurred in 305 (33.9%), 175 (32.9%), and 70 (22.6%) patients in the PCI, SAG, and MAG groups, respectively (P < 0.001). Multiple arterial grafting [adjusted hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.49-0.89], but not SAG (adjusted HR 0.83, 95% CI 0.67-1.03), was associated with significantly lower all-cause mortality compared with PCI. In patients with 3VD, both MAG (adjusted HR 0.55, 95% CI 0.37-0.81) and SAG (adjusted HR 0.68, 95% CI 0.50-0.91) were associated with significantly lower mortality than PCI, whereas in LMCAD patients, no significant differences between PCI and MAG (adjusted HR 0.90, 95% CI 0.56-1.46) or SAG (adjusted HR 1.11, 95% CI 0.81-1.53) were observed. In patients with revascularization of all three major myocardial territories, a positive correlation was observed between the number of myocardial territories receiving arterial grafts and survival (Ptrend = 0.003). CONCLUSION Our findings suggest that MAG might be the more desirable configuration for CABG to achieve lower long-term all-cause mortality than PCI in patients with 3VD and/or LMCAD. TRIAL REGISTRATION Registered on clinicaltrial.gov. SYNTAXES: NCT03417050 (https://clinicaltrials.gov/ct2/show/NCT03417050); SYNTAX: NCT00114972 (https://www.clinicaltrials.gov/ct2/show/NCT00114972).
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Affiliation(s)
- Piroze M Davierwala
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Changle West Road, Xi'an 710032, China.,Department of Cardiology, Radboud University, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, Changle West Road, Xi'an 710032, China.,Department of Cardiology, Radboud University, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Centre Leipzig, Strümpellstraße 39, Leipzig 04289, Germany
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Haslingden Rd, Blackburn BB2 3HH, UK
| | - Neil O'leary
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Marie-Claude Morice
- Department of Cardiology, Cardiovascular Institute Paris-Sud (ICPS), Hopital privé Jacques Cartier, Ramsay, Générale de Santé Massy, 6 Av. du Noyer Lambert, 91300 Massy, France
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246, USA
| | - Robert-Jan van Geuns
- Department of Cardiology, Radboud University, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, The Netherlands
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, USA
| | - David P Taggart
- Department of Cardiovascular Surgery, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Friedrich Wilhelm Mohr
- University Department of Cardiac Surgery, Heart Centre Leipzig, Strümpellstraße 39, Leipzig 04289, Germany
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
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Gaudino M, Di Franco A, Bhatt DL, Alexander JH, Abbate A, Azzalini L, Sandner S, Sharma G, Rao SV, Crea F, Fremes SE, Bangalore S. The association between coronary graft patency and clinical status in patients with coronary artery disease. Eur Heart J 2021; 42:1433-1441. [PMID: 33709098 DOI: 10.1093/eurheartj/ehab096] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/23/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023] Open
Abstract
The concept of a direct association between coronary graft patency and clinical status is generally accepted. However, the relationship is more complex and variable than usually thought. Key issues are the lack of a common definition of graft occlusion and of a standardized imaging protocol for patients undergoing coronary bypass surgery. Factors like the type of graft, the timing of the occlusion, and the amount of myocardium at risk, as well as baseline patients' characteristics, modulate the patency-to-clinical status association. Available evidence suggests that graft occlusion is more often associated with non-fatal events rather than death. Also, graft failure due to competitive flow is generally a benign event, while graft occlusion in a graft-dependent circulation is associated with clinical symptoms. In this systematic review, we summarize the evidence on the association between graft status and clinical outcomes.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
| | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, 70 Francis St, Boston, MA 02115, USA
| | - John H Alexander
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt St, Durham, NC 27705, USA
| | - Antonio Abbate
- Division of Cardiology, VCU Pauley Heart Center and Wright Center for Clinical and Translational Research, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA 23219, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA 23219, USA
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Sunil V Rao
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt St, Durham, NC 27705, USA
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, Roma 00168, Italy
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Sripal Bangalore
- Division of Cardiology, NYU Langone Health, 27 W 86th St, New York, NY 10024, USA
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7
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Rakhimov K, Buono A, Anadol R, Ullrich H, Knorr M, Ahoopai M, Münzel T, Gori T. Randomised, non-inferiority, controlled procedural outcomes TrIal comParing reverse T And Protrusion versus double-kissing and crush stenting: protocol of the TIP TAP I randomised trial. BMJ Open 2020; 10:e034264. [PMID: 32554736 PMCID: PMC7304799 DOI: 10.1136/bmjopen-2019-034264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION To assess the impact of 'reverse T and Protrusion' (TAP) technique on the outcome after stenting of true bifurcation lesions of the left main (LM) or proximal epicardial vessels as compared with double kissing (DK)-crush technique. METHODS AND ANALYSIS 50 consecutive patients with true coronary bifurcation lesion (Medina 1,1,1 or 0,1,1) of the LM or the proximal main vessels, requiring a two-stent technique as first-line strategy at University Medical Center Mainz, are randomised in a 1:1 ratio to reverse TAP or DK-crush stenting. As recommended by best clinical practice, final angiographic result is evaluated and optical coherence tomographic (OCT) intracoronary imaging is performed to assess and optimise the final result. The primary end point is defined as the percentage of stent expansion in the side branch. Secondary end points consist of angiographic and procedural success (assessed until patient's discharge), procedural parameters (procedural time, fluoroscopy time, use of devices, X-ray dose) and OCT parameters expressing expansion of the stents. Safety parameters include all adverse events up to 6 months after discharge. A clinical, angiographic and intracoronary imaging control at 6 months is planned. ETHICS AND DISSEMINATION The protocol complies with good clinical practice and the ethical principles described in the Declaration of Helsinki and is approved by the local ethics committee. The results of the trial will be published as original article(s) in medical journals and/or as presentation at congresses. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03714750).
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Affiliation(s)
- Kudrat Rakhimov
- Kardiologie I, Universitätsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
| | - Andrea Buono
- Kardiologie I, Universitätsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
| | - Remzi Anadol
- Kardiologie I, Universitätsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
- DZHK, Standort Rhein-Mainz, Universitätsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
| | - Helen Ullrich
- Kardiologie I, Universitätsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
| | - Maike Knorr
- Kardiologie I, Universitätsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
| | - Majid Ahoopai
- Kardiologie I, Universitätsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
| | - Thomas Münzel
- Kardiologie I, Universitätsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
- DZHK, Standort Rhein-Mainz, Universitätsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
| | - Tommaso Gori
- Kardiologie I, Universitätsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
- DZHK, Standort Rhein-Mainz, Universitätsmedizin Mainz, Mainz, Rheinland-Pfalz, Germany
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8
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Chen X, Li X, Zhang JJ, Han Y, Kan J, Chen L, Qiu C, Santoso T, Paiboon C, Kwan TW, Sheiban I, Leon MB, Stone GW, Chen SL. 3-Year Outcomes of the DKCRUSH-V Trial Comparing DK Crush With Provisional Stenting for Left Main Bifurcation Lesions. JACC Cardiovasc Interv 2019; 12:1927-1937. [DOI: 10.1016/j.jcin.2019.04.056] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 12/29/2022]
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9
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Intravascular ultrasound-guided drug-eluting stent implantation for patients with unprotected left main coronary artery lesions: A single-center randomized trial. Anatol J Cardiol 2019; 21:83-90. [PMID: 30694800 PMCID: PMC6457420 DOI: 10.14744/anatoljcardiol.2018.21447] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective: Intravascular ultrasound (IVUS) has developed as a preferable choice for optimizing the stenting procedures mainly because it will have good access to vessel size, lesion length, or severity accurately. However, it still remains unclear about the benefits of IVUS guidance in drug-eluting stent (DES) implantation for patients with unprotected left main coronary artery (ULMCA) stenosis. The aim of the present study was to evaluate the clinical outcomes with respect to IVUS-guided DES implantation for these patients. Methods: A total of 336 consecutive patients from December 2010 to December 2015 were enrolled in the study. The patients were then randomly assigned into two groups: IVUS-guided group (n=167) and control group (n=169). The primary endpoint was the incidence of composite major adverse cardiac events (MACEs), including cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR). The risk of stent thrombosis (ST) was chosen as the safety endpoint. Results: After a 1-year follow-up, the occurrence of composite MACE in the IVUS-guided group was significantly lower than that in the control group (13.2% vs. 21.9%, p=0.031), which might mainly result from the significant reduction in the risk of cardiac death (1.8% vs. 5.9%, p=0.048). Dramatically, the risk of MI did not differ significantly between the two groups (11.4% vs. 13.6%, p=0.478), though a tended reduction in TVR was observed under IVUS guidance (4.2% vs. 8.9%, p=0.068). There was no statistical significance between the two groups with respect to the risk of target lesion revascularization (IVUS-guided vs. control: 1.2% vs. 3.0%, p=0.239) and ST (IVUS-guided vs. control: 1.2% vs. 3.0%, p=0.246). Conclusion: The possible feasibility of IVUS-guided DES implantation for patients with ULMCA stenosis was supported by the present study. Larger and more powerful randomized trials were still warranted to research the whole benefits of IVUS guidance for these patients.
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Kawamoto H, Chieffo A, D'Ascenzo F, Jabbour RJ, Naganuma T, Cerrato E, Ugo F, Pavani M, Varbella F, Boccuzzi G, Pennone M, Garbo R, Conrotto F, Biondi-Zoccai G, D'Amico M, Moretti C, Escaned J, Gaita F, Nakamura S, Colombo A. Provisional versus elective two-stent strategy for unprotected true left main bifurcation lesions: Insights from a FAILS-2 sub-study. Int J Cardiol 2018; 250:80-85. [PMID: 28992999 DOI: 10.1016/j.ijcard.2017.09.207] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/26/2017] [Accepted: 09/18/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Hiroyoshi Kawamoto
- IRCCS Ospedale San Raffaele, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy; New Tokyo Hospital, Matsudo, Japan
| | | | | | - Richard J Jabbour
- IRCCS Ospedale San Raffaele, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy
| | | | | | | | - Marco Pavani
- Citta della Salute e della Scienza, Turin, Italy
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11
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Chen SL, Zhang JJ, Han Y, Kan J, Chen L, Qiu C, Jiang T, Tao L, Zeng H, Li L, Xia Y, Gao C, Santoso T, Paiboon C, Wang Y, Kwan TW, Ye F, Tian N, Liu Z, Lin S, Lu C, Wen S, Hong L, Zhang Q, Sheiban I, Xu Y, Wang L, Rab TS, Li Z, Cheng G, Cui L, Leon MB, Stone GW. Double Kissing Crush Versus Provisional Stenting for Left Main Distal Bifurcation Lesions: DKCRUSH-V Randomized Trial. J Am Coll Cardiol 2017; 70:2605-2617. [PMID: 29096915 DOI: 10.1016/j.jacc.2017.09.1066] [Citation(s) in RCA: 215] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/15/2017] [Accepted: 09/17/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Provisional stenting (PS) is the most common technique used to treat distal left main (LM) bifurcation lesions in patients with unprotected LM coronary artery disease undergoing percutaneous coronary intervention. The double kissing (DK) crush planned 2-stent technique has been shown to improve clinical outcomes in non-LM bifurcations compared with PS, and in LM bifurcations compared with culotte stenting, but has never been compared with PS in LM bifurcation lesions. OBJECTIVES The authors sought to determine whether a planned DK crush 2-stent technique is superior to PS for patients with true distal LM bifurcation lesions. METHODS The authors randomized 482 patients from 26 centers in 5 countries with true distal LM bifurcation lesions (Medina 1,1,1 or 0,1,1) to PS (n = 242) or DK crush stenting (n = 240). The primary endpoint was the 1-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Routine 13-month angiographic follow-up was scheduled after ascertainment of the primary endpoint. RESULTS TLF within 1 year occurred in 26 patients (10.7%) assigned to PS, and in 12 patients (5.0%) assigned to DK crush (hazard ratio: 0.42; 95% confidence interval: 0.21 to 0.85; p = 0.02). Compared with PS, DK crush also resulted in lower rates of target vessel myocardial infarction I (2.9% vs. 0.4%; p = 0.03) and definite or probable stent thrombosis (3.3% vs. 0.4%; p = 0.02). Clinically driven target lesion revascularization (7.9% vs. 3.8%; p = 0.06) and angiographic restenosis within the LM complex (14.6% vs. 7.1%; p = 0.10) also tended to be less frequent with DK crush compared with PS. There was no significant difference in cardiac death between the groups. CONCLUSIONS In the present multicenter randomized trial, percutaneous coronary intervention of true distal LM bifurcation lesions using a planned DK crush 2-stent strategy resulted in a lower rate of TLF at 1 year than a PS strategy. (Double Kissing and Double Crush Versus Provisional T Stenting Technique for the Treatment of Unprotected Distal Left Main True Bifurcation Lesions: A Randomized, International, Multi-Center Clinical Trial [DKCRUSH-V]; ChiCTR-TRC-11001213).
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Affiliation(s)
- Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital and Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaboratory Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China.
| | - Jue-Jie Zhang
- Division of Cardiology, Nanjing First Hospital and Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaboratory Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Yaling Han
- Division of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Jing Kan
- Division of Cardiology, Nanjing First Hospital and Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaboratory Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Lianglong Chen
- Division of Cardiology, United Hospital, Fujian Medical University, Fuzhou, China
| | - Chunguang Qiu
- Division of Cardiology, Zhengzhou University First Hospital, Zhengzhou, China
| | - Tiemin Jiang
- Division of Cardiology, Armed Police Medical University, Tianjin, China
| | - Ling Tao
- Division of Cardiology, Xijin Hospital, 4th Military Medical University, Xi'an, China
| | - Hesong Zeng
- Division of Cardiology, Wuhan Tongji Hospital, United Medical University, Wuhan, China
| | - Li Li
- Division of Cardiology, Guangzhou Red Cross Hospital, Guangzhou, Guangdong, China
| | - Yong Xia
- Division of Cardiology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Chuanyu Gao
- Division of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Teguh Santoso
- Division of Cardiology, Medistra Hospital, University of Indonesia Medical School, Jakarda, Indonesia
| | | | - Yan Wang
- Division of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Tak W Kwan
- Division of Cardiology, Beth Israel Hospital, New York, New York
| | - Fei Ye
- Division of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Nailiang Tian
- Division of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Zhizhong Liu
- Division of Cardiology, Nanjing First Hospital and Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaboratory Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Song Lin
- Division of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Chengzhi Lu
- Division of Cardiology, Tianjin 1(st) Central Hospital, Tianjin, China
| | - Shangyu Wen
- Division of Cardiology, Daqin Oil General Hospital, Daqin, China
| | - Lang Hong
- Division of Cardiology, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Qi Zhang
- Division of Cardiology, Shanghai East Hospital, Shanghai, China
| | - Imad Sheiban
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Yawei Xu
- Division of Cardiology, Shanghai 10th People's Hospital, Shanghai, China
| | - Lefeng Wang
- Division of Cardiology, Beijing Chaoyang Hospital, Beijing, China
| | - Tanveer S Rab
- Division of Cardiology, Emory University Hospital, Atlanta, Georgia
| | - Zhanquan Li
- Division of Cardiology, Liaoning Provincial People's Hospital, Shenyang, China
| | - Guanchang Cheng
- Division of Cardiology, Huaihe Hospital, Henan University, Kaifeng, China
| | - Lianqun Cui
- Division of Cardiology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Gregg W Stone
- Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
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12
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Kumar N, Kandan SR, Rahbi H, Mozid A, Johnson TW, Strange JW, Baumbach A. Single-centre experience of STENTYS Xposition S in treatment of left main stem lesions. Expert Rev Med Devices 2017. [DOI: 10.1080/17434440.2017.1344094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nitin Kumar
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Sri Raveen Kandan
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Hazim Rahbi
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Abdul Mozid
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Julian W Strange
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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13
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Takagi K, Naganuma T, Chieffo A, Fujino Y, Latib A, Tahara S, Ishiguro H, Montorfano M, Carlino M, Kawamoto H, Kurita N, Hozawa K, Nakamura S, Nakamura S, Colombo A. Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.003359. [DOI: 10.1161/circinterventions.116.003359] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 09/26/2016] [Indexed: 11/16/2022]
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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Affiliation(s)
- Kensuke Takagi
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Toru Naganuma
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Alaide Chieffo
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Yusuke Fujino
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Azeem Latib
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Satoko Tahara
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Hisaaki Ishiguro
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Matteo Montorfano
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Mauro Carlino
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Hiroyoshi Kawamoto
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Naoyuki Kurita
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Koji Hozawa
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Shotaro Nakamura
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Sunao Nakamura
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Antonio Colombo
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
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14
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Chen SL, Han YL, Chen LL, Qiu CG, Jiang TM, Tao L, Zeng H, Li L, Xia Y, Gao C, Santoso T, Paiboon C, wang Y, Kwan TW, Zhang JJ, Ye F, Tian NL, Liu ZZ, Lin S, Lu C, Wen S, Hong L, Zhang Q, Sheiban I, Xu Y, Wang L, Chen SY, Li Z, Cheng G, Cui L. Design and rationale for the treatment effects of provisional side branch stenting and DK crush stenting techniques in patients with unprotected distal left main coronary artery bifurcation lesions (DKCRUSH V) Trial. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ctrsc.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Kawamoto H, Takagi K, Chieffo A, Ruparelia N, Yusuke Fujino, Yabushita H, Watanabe Y, Latib A, Carlino M, Montorfano M, Nakamura S, Colombo A. Long-term outcomes following mini-crush versus culotte stenting for the treatment of unprotected left main disease: Insights from the milan and New-Tokyo (MITO) registry. Catheter Cardiovasc Interv 2016; 89:13-24. [DOI: 10.1002/ccd.26654] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 06/04/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroyoshi Kawamoto
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
- New Tokyo Hospital; Chiba Japan
| | | | - Alaide Chieffo
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - Neil Ruparelia
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
- Imperial College; London United Kingdom
| | | | | | | | - Azeem Latib
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
| | - Mauro Carlino
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
| | | | - Antonio Colombo
- Interventional Cardiology Unit; San Raffaele Scientific Institute; Milan Italy
- Interventional Cardiology Unit; EMO-GVM Centro Cuore Columbus; Milan Italy
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16
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Chen SL, Xu B, Han YL, Sheiban I, Zhang JJ, Ye F, Kwan TW, Paiboon C, Zhou YJ, Lv SZ, Dangas GD, Xu YW, Wen SY, Hong L, Zhang RY, Wang HC, Jiang TM, Wang Y, Sansoto T, Chen F, Yuan ZY, Li WM, Leon MB. Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left Main Bifurcation Lesions: The 3-Year Follow-Up Results of the DKCRUSH-III Study. JACC Cardiovasc Interv 2016; 8:1335-1342. [PMID: 26315736 DOI: 10.1016/j.jcin.2015.05.017] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/06/2015] [Accepted: 05/22/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The present study aimed to investigate the difference in major adverse cardiac events (MACE) at 3 years after double-kissing (DK) crush versus culotte stenting for unprotected left main distal bifurcation lesions (LMDBLs). BACKGROUND The multicenter and randomized DKCRUSH-III (Comparison of double kissing crush versus culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective study) showed that DK crush stenting was associated with fewer MACE at 1-year follow-up in patients with LMDBLs compared with culotte stenting. Here, we report the 3-year clinical outcome of the DKCRUSH-III study. METHODS A total of 419 patients with LMDBLs who were randomly assigned to either the DK crush or culotte group in the DKCRUSH-III study were followed for 3 year. The primary endpoint was the occurrence of a MACE at 3 years. Stent thrombosis (ST) was the safety endpoint. Patients were classified by simple and complex LMDBLs according to the DEFINITION (Definition and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents) study criteria. RESULTS At 3 years, MACE occurred in 49 patients the culotte group and in 17 patients in the DK crush group (cumulative event rates of 23.7% and 8.2%, respectively; p < 0.001), mainly driven by increased myocardial infarction (8.2% vs. 3.4%, respectively; p = 0.037) and target-vessel revascularization (18.8% vs. 5.8%, respectively; p < 0.001) between groups. Definite ST rate was 3.4% in the culotte group and 0% in the DK crush group (p = 0.007). Complex LMDBLs were associated with a higher rate of MACE (35.3%) at 3 years compared with a rate of 8.1% in patients with simple LMDBLs (p < 0.001), with an extremely higher rate in the culotte group (51.5% vs. 15.1%, p < 0.001). CONCLUSIONS Culotte stenting for LMDBLs was associated with significantly increased rates of MACE and ST. (Double Kissing [DK] Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions: DKCRUSH-III, a Multicenter Randomized Study Comparing Double-Stent Techniques; ChiCTR-TRC-11001877).
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Affiliation(s)
- Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Bo Xu
- Beijing Fuwai Cardiovascular Hospital, Beijing, China
| | | | - Imad Sheiban
- San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Jun-Jie Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tak W Kwan
- Beth Israel Hospital, New York, New York
| | | | - Yu-Jie Zhou
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shu-Zheng Lv
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Ya-Wei Xu
- Shanghai 10th Hospital, Shanghai, China
| | | | - Lang Hong
- Jiangxi Provincial People's Hospital, Nanchang, China
| | | | - Hai-Chang Wang
- Xijing Hospital, Xi'an 4th Military Medical University, Xi'an, China
| | - Tie-Ming Jiang
- Tianjing Policemen Medical College Hospital, Tianjing, China
| | - Yan Wang
- Xia'Men Zhongshan Hospital, Xia'Men, China
| | - Teguh Sansoto
- Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia
| | - Fang Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zu-Yi Yuan
- Xi'an Communication University Hospital, Xi'an, China
| | - Wei-Min Li
- Haarbin Medical University 1st Hospital, Haarbin, China
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York
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17
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Hoole SP, Clarke SC. Navigating Optimal Revascularization for Unprotected Left Main Disease in Changing Interventional Seas. JACC Cardiovasc Interv 2016; 9:1008-10. [PMID: 27198681 DOI: 10.1016/j.jcin.2016.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/14/2016] [Accepted: 03/18/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Stephen P Hoole
- Department of Interventional Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Sarah C Clarke
- Department of Interventional Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
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18
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Usefulness of sheathless guide catheter for the percutaneous coronary intervention of left main disease by radial approach. Int J Cardiol 2016; 211:49-52. [DOI: 10.1016/j.ijcard.2016.02.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/04/2016] [Accepted: 02/28/2016] [Indexed: 11/18/2022]
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19
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Angiographic and Clinical Outcomes After Everolimus-Eluting Stenting for Unprotected Left Main Disease and High Anatomic Coronary Complexity. JACC Cardiovasc Interv 2016; 9:1001-7. [DOI: 10.1016/j.jcin.2016.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/01/2016] [Accepted: 02/11/2016] [Indexed: 11/17/2022]
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20
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Gaudino M, Massetti M, Farina P, Hanet C, Etienne PY, Mazza A, Glineur D. Chronic competitive flow from a patent arterial or venous graft to the circumflex system does not impair the long-term patency of internal thoracic artery to left anterior descending grafts in patients with isolated predivisional left main disease: Long-term angiographic results of 2 different revascularization strategies. J Thorac Cardiovasc Surg 2014; 148:1856-9. [DOI: 10.1016/j.jtcvs.2014.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/20/2014] [Accepted: 02/03/2014] [Indexed: 11/25/2022]
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21
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Brilakis ES, Lee M, Mehilli J, Marmagkiolis K, Rodes-Cabau J, Sachdeva R, Kotsia A, Christopoulos G, Rangan BV, Mohammed A, Banerjee S. Saphenous Vein Graft Interventions. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:301. [DOI: 10.1007/s11936-014-0301-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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22
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Farooq V, Serruys PW, Zhang Y, Mack M, Ståhle E, Holmes DR, Feldman T, Morice MC, Colombo A, Bourantas CV, de Vries T, Morel MA, Dawkins KD, Kappetein AP, Mohr FW. Short-Term and Long-Term Clinical Impact of Stent Thrombosis and Graft Occlusion in the SYNTAX Trial at 5 Years. J Am Coll Cardiol 2013; 62:2360-2369. [DOI: 10.1016/j.jacc.2013.07.106] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/03/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
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23
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Farooq V, Girasis C, Magro M, Onuma Y, Morel MA, Heo JH, Garcia-Garcia H, Kappetein AP, van den Brand M, Holmes DR, Mack M, Feldman T, Colombo A, Ståhle E, James S, Carrié D, Fournial G, van Es GA, Dawkins KD, Mohr FW, Morice MC, Serruys PW. The CABG SYNTAX Score - an angiographic tool to grade the complexity of coronary disease following coronary artery bypass graft surgery: from the SYNTAX Left Main Angiographic (SYNTAX-LE MANS) substudy. EUROINTERVENTION 2013; 8:1277-85. [PMID: 23537954 DOI: 10.4244/eijv8i11a196] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The SYNTAX Score (SXscore) has established itself as an important prognostic tool in patients undergoing percutaneous coronary intervention (PCI). A limitation of the SXscore is the inability to differentiate outcomes in patients who have undergone prior coronary artery bypass graft (CABG) surgery. The CABG SXscore was devised to address this limitation. METHODS AND RESULTS In the SYNTAX-LE MANS substudy 115 patients with unprotected left main coronary artery disease (isolated or associated with one, two or three-vessel disease) treated with CABG were prospectively assigned to undergo a 15-month coronary angiogram. An independent core laboratory analysed the baseline SXscore prior to CABG. The 15-month CABG SXscore was calculated by a panel of three interventional cardiologists. The CABG SXscore was calculated by determining the standard SXscore in the "native" coronary vessels ("native SXscore") and deducting points based on the importance of the diseased coronary artery segment (Leaman score) that have a functioning bypass graft anastomosed distally. Points relating to intrinsic coronary disease, such as bifurcation disease or calcification, remain unaltered. The mean 15-month CABG SXscore was significantly lower compared to the mean baseline SXscore (baseline SXscore 31.6, SD 13.1; 15-month CABG SXscore 21.2, SD 11.1; p<0.001). Reproducibility analyses (kappa [k] statistics) indicated a substantial agreement between CABG SXscore measurements (k=0.70; 95% CI [0.50-0.90], p<0.001), with the points deducted to calculate the CABG SXscore the most reproducible measurement (k=0.74; 95% CI [0.53-0.95], p<0.001). Despite the limited power of the study, four-year outcome data (Kaplan-Meier curves) demonstrated a trend towards reduced all-cause death (9.1% vs. 1.8%, p=0.084) and death/CVA/MI (16.4% vs. 7.0%, p=0.126) in the low compared to the high CABG SXscore group. CONCLUSIONS In this pilot study the calculation of the CABG SXscore appeared feasible, reproducible and may have a long-term prognostic role in patients with complex coronary disease undergoing surgical revascularisation. Validation of this new scoring methodology is required.
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Affiliation(s)
- Vasim Farooq
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
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24
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Moynagh A, Salvatella N, Harb T, Darremont O, Boudou N, Dumonteil N, Lefèvre T, Carrié D, Louvard Y, Leymarie JL, Chevalier B, Morice MC, Garot P. Two-year outcomes of everolimus vs. paclitaxel-eluting stent for the treatment of unprotected left main lesions: a propensity score matching comparison of patients included in the French Left Main Taxus (FLM Taxus) and the LEft MAin Xience (LEMAX) registries. EUROINTERVENTION 2013; 9:452-62. [DOI: 10.4244/eijv9i4a74] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Roura G, Gomez-Lara J, Ferreiro JL, Gomez-Hospital JA, Romaguera R, Teruel LM, Carreño E, Esplugas E, Alfonso F, Cequier A. Multislice CT for assessing in-stent dimensions after left main coronary artery stenting: a comparison with three dimensional intravascular ultrasound. Heart 2013; 99:1106-12. [DOI: 10.1136/heartjnl-2013-303679] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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26
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Chen SL, Xu B, Han YL, Sheiban I, Zhang JJ, Ye F, Kwan TW, Paiboon C, Zhou YJ, Lv SZ, Dangas GD, Xu YW, Wen SY, Hong L, Zhang RY, Wang HC, Jiang TM, Wang Y, Chen F, Yuan ZY, Li WM, Leon MB. Comparison of Double Kissing Crush Versus Culotte Stenting for Unprotected Distal Left Main Bifurcation Lesions. J Am Coll Cardiol 2013; 61:1482-8. [DOI: 10.1016/j.jacc.2013.01.023] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/20/2012] [Accepted: 01/08/2013] [Indexed: 01/20/2023]
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27
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De Caterina AR, Cuculi F, Banning AP. Incidence, predictors and management of left main coronary artery stent restenosis: a comprehensive review in the era of drug-eluting stents. EUROINTERVENTION 2013; 8:1326-34. [DOI: 10.4244/eijv8i11a201] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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The negative impact of incomplete angiographic revascularization on clinical outcomes and its association with total occlusions: the SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial. J Am Coll Cardiol 2012; 61:282-94. [PMID: 23265332 DOI: 10.1016/j.jacc.2012.10.017] [Citation(s) in RCA: 215] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 10/16/2012] [Accepted: 10/30/2012] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The study sought to evaluate the clinical impact of angiographic complete (CR) and incomplete (ICR) revascularization and its association with the presence of total occlusions (TO), after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in the "all-comers" SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial. BACKGROUND In patients with complex coronary artery disease undergoing PCI or CABG, the long-term prognostic implications of CR versus ICR is unsettled. METHODS In this post hoc study, consisting of randomized (n = 1,800) and nested PCI (n = 198) and CABG (n = 649) registries, 4-year clinical outcomes were compared in groups, with and without angiographic CR, in the PCI and CABG arms. Clinical outcomes were analyzed with Kaplan-Meier estimates, log-rank comparisons, and Cox regression analyses. Multivariate predictors of ICR were determined. Similar analyses were undertaken in the TO and non-TO treated groups of both study arms. RESULTS Angiographic CR was achieved in 52.8% of the PCI arm and 66.9% of the CABG arm. Within the PCI and CABG arms, ICR (compared with CR) seemed to be a surrogate marker of a greater burden of anatomical coronary complexity and clinical comorbidity and was associated with significantly higher frequencies of 4-year mortality, all-cause revascularization, stent thrombosis (PCI arm), and major adverse cardiac and cerebrovascular events. The presence of a TO was the strongest independent predictor of ICR after PCI (hazard ratio: 2.70, 95% confidence interval: 1.98 to 3.67, p < 0.001). Eight hundred and forty patients (PCI: 26.3%, CABG: 36.4%, p < 0.001) were identified to have 1,007 TOs, with 68.1% of TOs located in the proximal-mid coronary vasculature. The findings associating ICR (compared with CR) with higher frequencies of 4-year mortality and major adverse cardiac and cerebrovascular events remained consistent in the TO-treated groups in the PCI and CABG arms. CONCLUSIONS Within the PCI and CABG arms of the all-comers SYNTAX trial, angiographically determined ICR has a detrimental impact on long-term clinical outcomes, including mortality. This effect remained consistent in patients with and without TOs.
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Clinical and angiographic outcomes of patients treated with everolimus-eluting stents or first-generation Paclitaxel-eluting stents for unprotected left main disease. J Am Coll Cardiol 2012; 60:1217-22. [PMID: 23017531 DOI: 10.1016/j.jacc.2012.05.038] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 05/25/2012] [Accepted: 05/28/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The goal of this study was to compare the outcomes of patients treated with everolimus-eluting stents (EES) with outcomes of patients treated with first-generation paclitaxel-eluting stents (PES) for unprotected left main disease (ULMD). BACKGROUND No data exist about the comparison of these 2 types of stents in ULMD. METHODS The primary endpoint of the study was a 1-year composite of cardiac death, nonfatal myocardial infarction, target vessel revascularization, and stroke (MACE). Secondary endpoints were 1-year target vessel failure (TVF) and 9-month angiographic in-segment restenosis >50%. RESULTS From 2004 to 2010, a total of 390 patients underwent ULMD percutaneous coronary intervention (224 received PES and 166 EES). The 1-year MACE rate was 21.9% in the PES group and 10.2% in the EES group (p = 0.002). TVF rate was 20.5% in the PES group and 7.8% in the EES group (p < 0.001). The in-segment restenosis rate was 5.2% in the EES group and 15.6% in the PES group (p = 0.002). EES and EuroSCORE were the only variables related to the risk of MACE. EES (odds ratio: 0.32; p = 0.007) was also independently related to the risk of restenosis. CONCLUSIONS EES implantation for ULMD is associated with a reduced incidence of 1-year MACE, TVF, and restenosis as compared with PES implantation.
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Chen SL, Zhang Y, Xu B, Ye F, Zhang J, Tian N, Liu Z, Qian X, Ding S, Li F, Zhang A, Liu Y, Lin S. Five-year clinical follow-up of unprotected left main bifurcation lesion stenting: one-stent versus two-stent techniques versus double-kissing crush technique. EUROINTERVENTION 2012; 8:803-14. [DOI: 10.4244/eijv8i7a123] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Farooq V, Serruys PW, Bourantas C, Vranckx P, Diletti R, Garcia Garcia HM, Holmes DR, Kappetein AP, Mack M, Feldman T, Morice MC, Colombo A, Morel MA, de Vries T, van Es GA, Steyerberg EW, Dawkins KD, Mohr FW, James S, Ståhle E. Incidence and multivariable correlates of long-term mortality in patients treated with surgical or percutaneous revascularization in the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial. Eur Heart J 2012; 33:3105-13. [DOI: 10.1093/eurheartj/ehs367] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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32
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Current world literature. Curr Opin Cardiol 2012; 27:682-95. [PMID: 23075824 DOI: 10.1097/hco.0b013e32835a0ad8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Shannon J, Colombo A. Additional data supporting the safety and effectiveness of unprotected left main interventions. EUROINTERVENTION 2011; 7:653-7. [PMID: 21986323 DOI: 10.4244/eijv7i6a105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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