Incidence and Management of Restenosis After Treatment of Unprotected Left Main Disease With Second-Generation Drug-Eluting Stents (from Failure in Left Main Study With 2nd Generation Stents–Cardiogroup III Study)

Fabrizio D'Ascenzo, Alaide Chieffo, Enrico Cerrato, Fabrizio Ugo, Marco Pavani, Hyroishi Kawamoto, Roberto di Summa, Ferdinando Varbella, Giacomo Boccuzzi, Pierluigi Omedè, Sara Rettegno, Roberto Garbo, Federico Conrotto, Antonio Montefusco, Giuseppe Biondi-Zoccai, Maurizio D'Amico, Claudio Moretti, Javier Escaned, Fiorenzo Gaita, Antonio Colombo

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Abstract

Incidence, predictors, and impact on prognosis of target lesion revascularization (TLR) for patients treated with second-generation drug-eluting stents (DESs) on unprotected left main (ULM) remain to be defined. The present study is a multicenter study including patients treated with a second-generation DES on ULM from June 2007 to January 2015. Rate of TLR was the primary end point. All cause death, myocardial infarction, target vessel revascularization, and stent thrombosis were the secondary end points. A total of 1,270 patients were enrolled: after a follow-up of 650 days (230 to 1,170), 47 (3.7%) of them underwent a re–percutaneous coronary intervention TLR on the left main, 22 during a planned angiographic follow-up. Extent of coronary artery disease was similar among groups (median value of Syntax of 27 ± 10 vs 26 ± 9, p = 0.45), as localization of the lesion in the ULM. Of patients reporting with TLR on ULM, 56% presented with a focal restenosis, 33% diffuse and 10% proliferative. At multivariate analysis, insulin-dependent diabetes mellitus increased risk of TLR (hazard ratio [HR] 2.0: 1.1 to 3.6, p = 0.04), whereas use of intravascular ultrasound resulted protective (HR 0.5: 0.3 to 0.9, p = 0.02). At follow-up, rates of cardiovascular death did not differ among the 2 groups (4% vs 4%, p = 0.95). At multivariate analysis, TLR on LM did not increase risk of all cause death (HR 0.4: 0.1 to 1.6, p = 0.22), whereas cardiogenic shock and III tertile of Syntax portended a worse prognosis (HR 4.5: 2.1 to 10.2, p = 0.01 and HR 1.4: 1.1 to 1.6, p = 0.03, respectively). In conclusion, repeated revascularization after implantation of second-generation DES on ULM represents an unfrequent event, being increased in insulin-dependent patients and reduced by intravascular ultrasound. Impact on prognosis remains neutral, being related to clinical presentation and extent of coronary artery disease.

Original languageEnglish
Pages (from-to)978-982
Number of pages5
JournalAmerican Journal of Cardiology
Volume119
Issue number7
DOIs
Publication statusPublished - Apr 1 2017

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

D'Ascenzo, F., Chieffo, A., Cerrato, E., Ugo, F., Pavani, M., Kawamoto, H., di Summa, R., Varbella, F., Boccuzzi, G., Omedè, P., Rettegno, S., Garbo, R., Conrotto, F., Montefusco, A., Biondi-Zoccai, G., D'Amico, M., Moretti, C., Escaned, J., Gaita, F., & Colombo, A. (2017). Incidence and Management of Restenosis After Treatment of Unprotected Left Main Disease With Second-Generation Drug-Eluting Stents (from Failure in Left Main Study With 2nd Generation Stents–Cardiogroup III Study). American Journal of Cardiology, 119(7), 978-982. https://doi.org/10.1016/j.amjcard.2016.12.005