Impact of Final Kissing Balloon and of Imaging on Patients Treated on Unprotected Left Main Coronary Artery With Thin-Strut Stents (From the RAIN-CARDIOGROUP VII Study)

D’Ascenzo, Fabrizio; Omedè, Pierluigi; Filippo, Ovidio De; Cerrato, Enrico; Autelli, Michele; Trabattoni, Daniela; Ryan, Nicola; Venuti, Giuseppe; Muscoli, Saverio; Montabone, Andrea; Wojakowski, Wojciech; Rognoni, Andrea; Helft, Gérard; Gallo, Diego; Parma, Radosław; Luca, Leonardo De; Figini, Filippo; Mitomo, Satoru; Boccuzzi, Giacomo; Mattesini, Alessio; Wańha, Wojciech; Smołka, Grzegorz; Huczek, Zenon; Cortese, Bernardo; Sheiban, Imad; Escaned, Javier; Biolè, Carloalberto; Conrotto, Federico; Templin, Christian; Quadri, Giorgio; Rolfo, Cristina; Capodanno, Davide; Chieffo, Alaide; Núñez‐Gil, Iván J.; Morbiducci, Umberto; Iannaccone, Mario; Gili, Sebastiano; Mario, Carlo Di; Moretti, Claudio; D’Amico, Maurizio; Varbella, Ferdinando; Romeo, Francesco; Lüscher, Thomas F.

doi:10.1016/j.amjcard.2019.02.013

Cited by 21 publications

(11 citation statements)

References 27 publications

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“…The RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry is a multicenter study (see Appendix web only for sites of enrollment, NCT03622203) that retrospectively recruited patients from June 2015 to January 2017 19 …”

Section: Methodsmentioning

confidence: 99%

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Accuracy of the PARIS score and PCI complexity to predict ischemic events in patients treated with very thin stents in unprotected left main or coronary bifurcations

Gallone

D’Ascenzo

Conrotto

et al. 2020

Cathet Cardio Intervent

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Background The PARIS risk score (PARIS‐rs) and percutaneous coronary intervention complexity (PCI‐c) predict clinical and procedural residual ischemic risk following PCI. Their accuracy in patients undergoing unprotected left main (ULM) or bifurcation PCI has not been assessed. Methods The predictive performances of the PARIS‐rs (categorized as low, intermediate, and high) and PCI‐c (according to guideline‐endorsed criteria) were evaluated in 3,002 patients undergoing ULM/bifurcation PCI with very thin strut stents. Results After 16 (12–22) months, increasing PARIS‐rs (8.8% vs. 14.1% vs. 27.4%, p < .001) and PCI‐c (15.2% vs. 11%, p = .025) were associated with higher rates of major adverse cardiac events ([MACE], a composite of death, myocardial infarction [MI], and target vessel revascularization), driven by MI/death for PARIS‐rs and target lesion revascularization/stent thrombosis for PCI‐c (area under the curves for MACE: PARIS‐rs 0.60 vs. PCI‐c 0.52, p‐for‐difference < .001). PCI‐c accuracy for MACE was higher in low‐clinical‐risk patients; while PARIS‐rs was more accurate in low‐procedural‐risk patients. ≥12‐month dual antiplatelet therapy (DAPT) was associated with a lower MACE rate in high PARIS‐rs patients, (adjusted‐hazard ratio 0.42 [95% CI: 0.22–0.83], p = .012), with no benefit in low to intermediate PARIS‐rs patients. No incremental benefit with longer DAPT was observed in complex PCI. Conclusions In the setting of ULM/bifurcation PCI, the residual ischemic risk is better predicted by a clinical risk estimator than by PCI complexity, which rather appears to reflect stent/procedure‐related events. Careful procedural risk estimation is warranted in patients at low clinical risk, where PCI complexity may substantially contribute to the overall residual ischemic risk.

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Section: Methodsmentioning

confidence: 99%

“…All consecutive patients presenting with a critical lesion of an ULM or a coronary bifurcation (see Appendix web only for definition) and treated with a very thin stent in our centers were included in the RAIN registry. Study design details have been previously described 19 …”

Section: Methodsmentioning

confidence: 99%

Accuracy of the PARIS score and PCI complexity to predict ischemic events in patients treated with very thin stents in unprotected left main or coronary bifurcations

Gallone

D’Ascenzo

Conrotto

et al. 2020

Cathet Cardio Intervent

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“…Our brief investigation has some limitations including the relatively small number of patients enrolled, the monocentric and retrospective design of the study, and the potential impact on outcomes of different stent strategy, optimization techniques, and stent composition [ 9 ]. Moreover, the exclusion of patients immediately referred to bypass surgery or not treated with PCI could represent a bias.…”

Section: Discussionmentioning

confidence: 99%

Occurence of left main occlusion on Tuesday: Chronobiology of acute myocardial infarction

Rigatelli¹,

Zuin²

2020

Journal of the Saudi Heart Association

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Objectives The existence of a “weekend effect” for onset of acute myocardial infarction (AMI) has been suggested in the past, but the relation with the culprit vessel has not been investigated. MI due to left main coronary artery lesion represents a particularly serious life-threatening condition. Our study was aimed to assess the chronobiology of admission to the emergency department for AMI considered to be induced by a left main culprit lesion. Methods We retrospectively reviewed patients who experienced an AMI due to a left main culprit lesion between January 1, 2008 and January 1, 2018 stratifying them according to the day of admission, on the basis of the symptom onset time; the 30-day cardiovascular mortality was also analyzed on the basis of the time of symptom onset. Results Out of 1789 patients with AMI, 130 (7.2%, 104 males and 26 females, mean age 74.5 ± 8.1 years) had left main disease as the culprit lesion. Tuesday was significantly over-represented as the admission day ( p < 0.001 for Tuesday vs. other days; p = 0.009 for Tuesday vs. Sunday, respectively). The 30-day cardiovascular survival was not different between patients admitted on Tuesday and those admitted on remaining days (Log-rank, Mantel Cox, p = 0.43; Chi-square = 0.611). A significant difference was noted in patients with AMI on Sunday versus remaining days (Log-rank, Mantel-Cox, p = 0.005; Chi-square = 7.96). The diameter of the left main artery was larger in patients admitted on Tuesdays than on Sundays ( p < 0.01). Conclusion The relation between AMI onset and the day of the week is confirmed by our study, which also suggests that in case of a left main lesion, some delay of the weekend effect might be expected.

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“…What's more, with the development of technology, some technique such as IVUS, OCT and kissing balloon may improve prognosis. The kissing balloon can reduce the risk of overall target lesion revascularization while the IVUS and OCT can be used to optimize stenting and guide procedural strategy (34,35). PCI may also be preferred because of its improved early safety profile.…”

Section: Discussionmentioning

confidence: 99%

Second drug-eluting stent implantation versus coronary artery bypass grafting in treatment of young patients with left main and/or multivessel coronary disease

Chen

Zhang

Yan

et al. 2019

Preprint

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Background Many studies have compared outcomes of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) for complex coronary artery disease (CAD). However, no trials have focused on young patients (< 45 years) with complex CAD. We conducted a retrospective evaluation to compare the outcomes of a 2nd drug-eluting stent and CABG in young patients with LM or three-vessel disease. Methods In the young patients with complex CAD who underwent PCI or CABG, Kaplan-Meier analysis and Cox regression before and after propensity-score matching were used to compare major adverse cardiac and cerebrovascular events (MACCE), including myocardial infarction (MI), stoke, death and repeat revascularization. Results During the follow-up, MACCE occurred in 20.5% of patients in the PCI group and 8.6% in the CABG group (hazard ratio [HR]: 3.263, 95% confidence interval [CI]: 1.379 to 7.722, p=0.007). Repeat revascularization occurred more frequently in the PCI group (18.9% vs. 3.7% respectively, HR: 6.968, 95% CI: 2.036 to 23.842, p=0.002). There were no significant differences in other endpoints. After propensity-score matching, no conclusions were changed. Conclusions In young patients with LM or three-vessel disease, PCI showed a higher incidence of MACCE, which was mainly driven by repeat revascularization. However that did not translate into hard endpoints differences. Therefore, PCI is an alternative treatment to CABG in young patients with complex CAD.

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Impact of Final Kissing Balloon and of Imaging on Patients Treated on Unprotected Left Main Coronary Artery With Thin-Strut Stents (From the RAIN-CARDIOGROUP VII Study)

Cited by 21 publications

References 27 publications

Accuracy of the PARIS score and PCI complexity to predict ischemic events in patients treated with very thin stents in unprotected left main or coronary bifurcations

Accuracy of the PARIS score and PCI complexity to predict ischemic events in patients treated with very thin stents in unprotected left main or coronary bifurcations

Occurence of left main occlusion on Tuesday: Chronobiology of acute myocardial infarction

Second drug-eluting stent implantation versus coronary artery bypass grafting in treatment of young patients with left main and/or multivessel coronary disease

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