The impact of main branch restenosis on long term mortality following drug-eluting stent implantation in patients with de novo unprotected distal left main bifurcation coronary lesions: The Milan and New-Tokyo (MITO) registry

Kensuke Takagi, Alfonso Ielasi, Sandeep Basavarajaiah, Alaide Chieffo, Joanne Shannon, Cosmo Godino, Tasuku Hasegawa, Toru Naganuma, Yusuke Fujino, Azeem Latib, Mauro Carlino, Matteo Montorfano, Sunao Nakamura, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

Background In-stent restenosis (ISR) remains one of the main limitations for percutaneous coronary intervention of unprotected distal left main (UDLM). This study aims to demonstrate the impact of main-branch ISR (MB-ISR) on mortality and to clarify the optimal strategy. Methods Between 2002 and 2008, 482 consecutive UDLM patients treated with drug eluting stent (sirolimus and paclitaxel) were evaluated. Results During follow-up period (median 52.6 months), MB-ISR occurred in 29, SB-ISR in 65, and MB/SB-ISR in 24. Multivariable analysis demonstrated that the independent predictors of MB-ISR were calcification (HR 2.284, p=0.016), true-bifurcation (HR 2.331, p=0.024), insulin-dependent diabetes mellitus (insulin-DM) (HR 2.259, p=0.048). Furthermore, final proximal postdilatation (FPPD) (HR 0.548, p=0.077), full LM cover approach (FCA) (HR 0.605, p=0.093) and greater MLD (HR 0.611, p=0.062) had a tendency to reduce MB-ISR. Furthermore, the occurrence of MB-ISR within 1-year was associated with cardiac-death (HR 2.734, p=0.017). Conclusions The patients with MB-ISR had more comorbidities and complex lesions, resulting in higher risk of cardiac mortality as compared to the patients without MB-ISR. Presence of calcification, true-bifurcation and insulin-DM were associated with MB-ISR following UDLM intervention, while FCA, FPPD, and greater MLD seemed to be associated with the low occurrence of MB-ISR.

Original languageEnglish
Pages (from-to)341-348
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume84
Issue number3
DOIs
Publication statusPublished - Sep 1 2014

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Drug-Eluting Stents
Tokyo
Stents
Registries
Mortality
Type 1 Diabetes Mellitus
Sirolimus
Percutaneous Coronary Intervention
Paclitaxel
Comorbidity

Keywords

  • coronary bifurcation
  • drug eluting stent
  • left main disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

The impact of main branch restenosis on long term mortality following drug-eluting stent implantation in patients with de novo unprotected distal left main bifurcation coronary lesions : The Milan and New-Tokyo (MITO) registry. / Takagi, Kensuke; Ielasi, Alfonso; Basavarajaiah, Sandeep; Chieffo, Alaide; Shannon, Joanne; Godino, Cosmo; Hasegawa, Tasuku; Naganuma, Toru; Fujino, Yusuke; Latib, Azeem; Carlino, Mauro; Montorfano, Matteo; Nakamura, Sunao; Colombo, Antonio.

In: Catheterization and Cardiovascular Interventions, Vol. 84, No. 3, 01.09.2014, p. 341-348.

Research output: Contribution to journalArticle

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abstract = "Background In-stent restenosis (ISR) remains one of the main limitations for percutaneous coronary intervention of unprotected distal left main (UDLM). This study aims to demonstrate the impact of main-branch ISR (MB-ISR) on mortality and to clarify the optimal strategy. Methods Between 2002 and 2008, 482 consecutive UDLM patients treated with drug eluting stent (sirolimus and paclitaxel) were evaluated. Results During follow-up period (median 52.6 months), MB-ISR occurred in 29, SB-ISR in 65, and MB/SB-ISR in 24. Multivariable analysis demonstrated that the independent predictors of MB-ISR were calcification (HR 2.284, p=0.016), true-bifurcation (HR 2.331, p=0.024), insulin-dependent diabetes mellitus (insulin-DM) (HR 2.259, p=0.048). Furthermore, final proximal postdilatation (FPPD) (HR 0.548, p=0.077), full LM cover approach (FCA) (HR 0.605, p=0.093) and greater MLD (HR 0.611, p=0.062) had a tendency to reduce MB-ISR. Furthermore, the occurrence of MB-ISR within 1-year was associated with cardiac-death (HR 2.734, p=0.017). Conclusions The patients with MB-ISR had more comorbidities and complex lesions, resulting in higher risk of cardiac mortality as compared to the patients without MB-ISR. Presence of calcification, true-bifurcation and insulin-DM were associated with MB-ISR following UDLM intervention, while FCA, FPPD, and greater MLD seemed to be associated with the low occurrence of MB-ISR.",
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T1 - The impact of main branch restenosis on long term mortality following drug-eluting stent implantation in patients with de novo unprotected distal left main bifurcation coronary lesions

T2 - The Milan and New-Tokyo (MITO) registry

AU - Takagi, Kensuke

AU - Ielasi, Alfonso

AU - Basavarajaiah, Sandeep

AU - Chieffo, Alaide

AU - Shannon, Joanne

AU - Godino, Cosmo

AU - Hasegawa, Tasuku

AU - Naganuma, Toru

AU - Fujino, Yusuke

AU - Latib, Azeem

AU - Carlino, Mauro

AU - Montorfano, Matteo

AU - Nakamura, Sunao

AU - Colombo, Antonio

PY - 2014/9/1

Y1 - 2014/9/1

N2 - Background In-stent restenosis (ISR) remains one of the main limitations for percutaneous coronary intervention of unprotected distal left main (UDLM). This study aims to demonstrate the impact of main-branch ISR (MB-ISR) on mortality and to clarify the optimal strategy. Methods Between 2002 and 2008, 482 consecutive UDLM patients treated with drug eluting stent (sirolimus and paclitaxel) were evaluated. Results During follow-up period (median 52.6 months), MB-ISR occurred in 29, SB-ISR in 65, and MB/SB-ISR in 24. Multivariable analysis demonstrated that the independent predictors of MB-ISR were calcification (HR 2.284, p=0.016), true-bifurcation (HR 2.331, p=0.024), insulin-dependent diabetes mellitus (insulin-DM) (HR 2.259, p=0.048). Furthermore, final proximal postdilatation (FPPD) (HR 0.548, p=0.077), full LM cover approach (FCA) (HR 0.605, p=0.093) and greater MLD (HR 0.611, p=0.062) had a tendency to reduce MB-ISR. Furthermore, the occurrence of MB-ISR within 1-year was associated with cardiac-death (HR 2.734, p=0.017). Conclusions The patients with MB-ISR had more comorbidities and complex lesions, resulting in higher risk of cardiac mortality as compared to the patients without MB-ISR. Presence of calcification, true-bifurcation and insulin-DM were associated with MB-ISR following UDLM intervention, while FCA, FPPD, and greater MLD seemed to be associated with the low occurrence of MB-ISR.

AB - Background In-stent restenosis (ISR) remains one of the main limitations for percutaneous coronary intervention of unprotected distal left main (UDLM). This study aims to demonstrate the impact of main-branch ISR (MB-ISR) on mortality and to clarify the optimal strategy. Methods Between 2002 and 2008, 482 consecutive UDLM patients treated with drug eluting stent (sirolimus and paclitaxel) were evaluated. Results During follow-up period (median 52.6 months), MB-ISR occurred in 29, SB-ISR in 65, and MB/SB-ISR in 24. Multivariable analysis demonstrated that the independent predictors of MB-ISR were calcification (HR 2.284, p=0.016), true-bifurcation (HR 2.331, p=0.024), insulin-dependent diabetes mellitus (insulin-DM) (HR 2.259, p=0.048). Furthermore, final proximal postdilatation (FPPD) (HR 0.548, p=0.077), full LM cover approach (FCA) (HR 0.605, p=0.093) and greater MLD (HR 0.611, p=0.062) had a tendency to reduce MB-ISR. Furthermore, the occurrence of MB-ISR within 1-year was associated with cardiac-death (HR 2.734, p=0.017). Conclusions The patients with MB-ISR had more comorbidities and complex lesions, resulting in higher risk of cardiac mortality as compared to the patients without MB-ISR. Presence of calcification, true-bifurcation and insulin-DM were associated with MB-ISR following UDLM intervention, while FCA, FPPD, and greater MLD seemed to be associated with the low occurrence of MB-ISR.

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