Distal left main coronary bifurcation lesions predict worse outcome in patients undergoing percutaneous implantation of drug-eluting stents: Results from the drug-eluting stent for the treatment of left main disease (DISTAL) study

Shao Liang Chen, Fei Ye, Jun Jie Zhang, Zhi Zhong Liu, Song Lin, Zhong Sheng Zhu, Xue Wen Sun, Feng Li, Ai Ping Zhang, Jin Guo Chen, Qing Jiong Ji, Jun Qian, Feng Chen, Tak W. Kwan

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19 Scopus citations

Abstract

Objectives: We investigated the clinical outcome of stenting of unprotected left main coronary artery (LMCA). Methods: We studied 164 patients with nonbifurcated LMCA lesions (group A) and 96 patients with distal bifurcated lesions (group B). Results: Clinical follow-up was available in 100%. Angiographic follow-up was 87.3% in group A and 86% in group B (p = 0.922). There were significant differences in major adverse cardiac events at 1 (p = 0.014) and 2 years (p = 0.002) between group B (19.8%, 25.0%) and group A (9.1%, 10.4%), mainly due to increased target-vessel revascularization (16.7, 21.9% in group B vs. 6.1, 7.3% in group A, p = 0.006 and 0.001, respectively). The double-stent technique was associated with worse outcomes at 1 year in group B compared to group A. Bifurcation lesions (HR 3.42, 95% CI 1.34-5.61, p = 0.001), diabetes (HR 2.68, 95% CI 2.01-12.11, p = 0.015), three-vessel disease (HR 0.83, 95% CI 0.27-0.96, p = 0.001), incomplete revascularization (HR 0.15, 95% CI 0.11-0.35, p = 0.001) and stent diameter (HR 5.05, 95% CI 2.71-10.01, p = 0.03) were the independent factors of major adverse cardiac events in the whole patient cohort. Conclusion: Stenting unprotected distal bifurcated LMCA was associated with unfavorable results when compared to stenting other LMCA lesions.

Original languageEnglish
Pages (from-to)264-273
Number of pages10
JournalCardiology
Volume113
Issue number4
DOIs
StatePublished - Jul 2009
Externally publishedYes

Keywords

  • Drug-eluting stent(s)
  • Major adverse cardiac events
  • Unprotected left main

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