Long-term clinical outcomes after percutaneous coronary intervention for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery: The DELTA Registry (Drug-Eluting Stent for Left Main Coronary Artery Disease): A multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment

Toru Naganuma, Alaide Chieffo, Emanuele Meliga, Davide Capodanno, Seung Jung Park, Yoshinobu Onuma, Marco Valgimigli, Sanda Jegere, Raj R. Makkar, Igor F. Palacios, Charis Costopoulos, Young Hak Kim, Piotr P. Buszman, Tarun Chakravarty, Imad Sheiban, Roxana Mehran, Christoph Naber, Ronan Margey, Arvind Agnihotri, Sebastiano MarraPiera Capranzano, Martin B. Leon, Jeffrey W. Moses, Jean Fajadet, Thierry Lefevre, Marie Claude Morice, Andrejs Erglis, Corrado Tamburino, Ottavio Alfieri, Patrick W. Serruys, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

Objectives The aim of this study was to compare, in a large all-comer registry, the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery (ULMCA) stenosis. Background Limited data are available regarding clinical outcomes following DES implantation at the different ULMCA sites. Methods Patients with ULMCA stenosis treated by PCI with DES were analyzed in this multinational registry. Results A total of 1,612 patients were included: 482 were treated for ostial/mid-shaft lesions versus 1,130 for distal bifurcation lesions. At a median follow-up period of 1,250 (interquartile range: 987 to 1,564) days, PCI for distal bifurcation lesions was associated with a higher incidence of major adverse cardiac events (propensity-score adjusted hazard ratio [HR]: 1.48, 95% confidence interval [CI]: 1.16 to 1.89; p = 0.001), largely because of the higher target vessel revascularization rate observed in this group as compared to the ostial/mid-shaft lesions group (propensity-score adjusted HR: 1.68, 95% CI: 1.19 to 2.38; p = 0.003). These results were sustained following propensity-score matched analysis. With regard to all-cause death and the composite endpoint of all-cause death and myocardial infarction, propensity-score adjusted analysis suggested a trend toward higher rates of these in the distal ULMCA PCI group, although this was not observed in the propensity-score matched analysis. Conclusions This study demonstrates that PCI for ostial/mid-shaft lesions is associated with better clinical outcomes than are distal bifurcation lesions in ULMCA, largely because there is a lower need for repeat revascularization in ostial/mid-shaft lesions.

Original languageEnglish
Pages (from-to)1242-1249
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume6
Issue number12
DOIs
Publication statusPublished - 2013

Keywords

  • distal bifurcation lesion
  • drug-eluting stent(s)
  • ostial/mid-shaft lesion
  • unprotected left main coronary artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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