Planned angiographic control versus clinical follow-up for patients with unprotected left main stem stenosis treated with second generation drug-eluting stents: A propensity score with matching analysis from the FAILS (failure in left main with second generation stents-Cardiogroup III Study)

F D'Ascenzo, M Iannaccone, Marco Pavani, H Kawamoto, J Escaned, F Varbella, Giacomo Boccuzzi, D Hiddick-Smith, A Colombo, F Gaita

Research output: Contribution to journalArticle

Abstract

Background: The value of angiographic follow-up in unprotected left main (ULM) stenting remains undefined. Methods: The FAILS-2 registry included consecutive patients presenting with a critical lesion of an ULM treated with second generation drug eluting stents in 6 centers from June 2007 to January 2015. Patients were stratified into two groups: those discharged with planned angiographic follow-up and those with clinical follow-up. MACE (Major Adverse Clinical Events, a composite end point of death, myocardial infarction, TLR, and ST) was the primary end point, while each component was a secondary endpoint Sensitivity analysis was performed for patients treated with a provisional or a two-stent strategy. A propensity score analysis was used to compare the outcomes in the two groups. Results: After multivariate adjustment, 220 patients per group were selected. Planned angiographic follow up was performed after a median of 7 (6-10) months. After 16 (14-21) months, rates of MACE were similar between the two groups (24 vs. 21%, P=0.29) with lower rates of all cause and cardiovascular death in the angiographic control group (6 vs. 14%, P=0.01 and 3 vs. 6%, P=0.04) but with higher rates of TLR (15 vs. 5%, P <0.001). The same trend was seen irrespective of the stent strategy. Conclusion: planned angiographic control results in more TLR but may reduce mortality. These findings need to be confirmed by adequately powered randomized controlled trial. © 2017 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)E271-E277
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume92
Issue number4
DOIs
Publication statusPublished - 2018

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Propensity Score
Drug-Eluting Stents
Stents
Pathologic Constriction
Registries
Cause of Death
Randomized Controlled Trials
Myocardial Infarction
Control Groups
Mortality

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Planned angiographic control versus clinical follow-up for patients with unprotected left main stem stenosis treated with second generation drug-eluting stents: A propensity score with matching analysis from the FAILS (failure in left main with second generation stents-Cardiogroup III Study). / D'Ascenzo, F; Iannaccone, M; Pavani, Marco; Kawamoto, H; Escaned, J; Varbella, F; Boccuzzi, Giacomo; Hiddick-Smith, D; Colombo, A; Gaita, F.

In: Catheterization and Cardiovascular Interventions, Vol. 92, No. 4, 2018, p. E271-E277.

Research output: Contribution to journalArticle

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abstract = "Background: The value of angiographic follow-up in unprotected left main (ULM) stenting remains undefined. Methods: The FAILS-2 registry included consecutive patients presenting with a critical lesion of an ULM treated with second generation drug eluting stents in 6 centers from June 2007 to January 2015. Patients were stratified into two groups: those discharged with planned angiographic follow-up and those with clinical follow-up. MACE (Major Adverse Clinical Events, a composite end point of death, myocardial infarction, TLR, and ST) was the primary end point, while each component was a secondary endpoint Sensitivity analysis was performed for patients treated with a provisional or a two-stent strategy. A propensity score analysis was used to compare the outcomes in the two groups. Results: After multivariate adjustment, 220 patients per group were selected. Planned angiographic follow up was performed after a median of 7 (6-10) months. After 16 (14-21) months, rates of MACE were similar between the two groups (24 vs. 21{\%}, P=0.29) with lower rates of all cause and cardiovascular death in the angiographic control group (6 vs. 14{\%}, P=0.01 and 3 vs. 6{\%}, P=0.04) but with higher rates of TLR (15 vs. 5{\%}, P <0.001). The same trend was seen irrespective of the stent strategy. Conclusion: planned angiographic control results in more TLR but may reduce mortality. These findings need to be confirmed by adequately powered randomized controlled trial. {\circledC} 2017 Wiley Periodicals, Inc.",
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AU - D'Ascenzo, F

AU - Iannaccone, M

AU - Pavani, Marco

AU - Kawamoto, H

AU - Escaned, J

AU - Varbella, F

AU - Boccuzzi, Giacomo

AU - Hiddick-Smith, D

AU - Colombo, A

AU - Gaita, F

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AB - Background: The value of angiographic follow-up in unprotected left main (ULM) stenting remains undefined. Methods: The FAILS-2 registry included consecutive patients presenting with a critical lesion of an ULM treated with second generation drug eluting stents in 6 centers from June 2007 to January 2015. Patients were stratified into two groups: those discharged with planned angiographic follow-up and those with clinical follow-up. MACE (Major Adverse Clinical Events, a composite end point of death, myocardial infarction, TLR, and ST) was the primary end point, while each component was a secondary endpoint Sensitivity analysis was performed for patients treated with a provisional or a two-stent strategy. A propensity score analysis was used to compare the outcomes in the two groups. Results: After multivariate adjustment, 220 patients per group were selected. Planned angiographic follow up was performed after a median of 7 (6-10) months. After 16 (14-21) months, rates of MACE were similar between the two groups (24 vs. 21%, P=0.29) with lower rates of all cause and cardiovascular death in the angiographic control group (6 vs. 14%, P=0.01 and 3 vs. 6%, P=0.04) but with higher rates of TLR (15 vs. 5%, P <0.001). The same trend was seen irrespective of the stent strategy. Conclusion: planned angiographic control results in more TLR but may reduce mortality. These findings need to be confirmed by adequately powered randomized controlled trial. © 2017 Wiley Periodicals, Inc.

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