Two-Year Clinical Outcome With Drug-Eluting Stents Versus Bare-Metal Stents in a Real-World Registry of Unprotected Left Main Coronary Artery Stenosis from the Italian Society of Invasive Cardiology

Palmerini, Tullio; Marzocchi, Antonío; Tamburino, Corrado; Sheiban, Imad; Margheri, Massimo; Vecchi, Giuseppe; Sangiorgi, Giuseppe; Santarelli, Andrea; Bartorelli, Antonio L.; Briguori, Carlo; Vignali, Luigi; Pede, Francesco Di; Ramondo, Angelo; Inglese, Luigi; Carlo, Marco De; Bolognese, Leonardo; Benassi, Alberto; Palmieri, Cataldo; Filippone, Vincenzo; Sangiorgi, Diego; Servi, Stefano De

doi:10.1016/j.amjcard.2008.07.030

Cited by 58 publications

(37 citation statements)

References 20 publications

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“…En unos pocos estudios se ha observado tambié n que la disfunció n renal es un factor independiente predictivo de mortalidad en esos pacientes 14,27 . El tratamiento de la estenosis de TCI no protegido con SM se ha relacionado con un aumento del riesgo de reestenosis del TCI en varios ensayos, pero solamente Palmerini et al 28 han…”

Section: Discusió Nunclassified

Seguimiento a largo plazo tras el tratamiento percutáneo del tronco coronario izquierdo no protegido en pacientes de alto riesgo no aptos para cirugía de revascularización

Gómez‐Hospital

Gomez‐Lara

Rondán

et al. 2012

Revista Española de Cardiología

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Section: Discusió Nunclassified

Seguimiento a largo plazo tras el tratamiento percutáneo del tronco coronario izquierdo no protegido en pacientes de alto riesgo no aptos para cirugía de revascularización

Gómez‐Hospital

Gomez‐Lara

Rondán

et al. 2012

Revista Española de Cardiología

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“…Uses of DES either Sirolimus or Paclitaxel eluting stents shows significant reduction of repeat revascularization and mortality over the uses of BMS. [8][9][10] In particular, ISAR left Main Trial randomized to Sirolimus eluting stent (SES) or Paclitaxel eluting stent (PES). At one year, the cumulative incidence of death, MI or Target vessel revascularization (TVR) was 13.6% in PES treated patient and 15.8% in SES treated patients (p=0.44).…”

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confidence: 99%

Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention-Our Experiences at a Tertiary Hospital

et al. 2014

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Background: Aim of the study was to evaluate the primary procedural success of percutaneous coronary intervention of unprotected left main coronary artery stenosis using either Bare-metal stents or drug eluting stent. Methods: Total 33 patients were enrolled in this very preliminary non-randomized prospective cohort study. Among them, Male: 25 and Female: 8. Total 35 stents were deployed. Mean age were for Male: 59 yrs, for Female: 62 yrs. Associated coronary artery diseases risk factors were dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive family history for coronary artery diseases and smoking. Results: Among the study group; 26 (78%) were Dyslipidemic, 24(70%) were hypertensive; 17 (51.5%) patients were Diabetic, 11(33%) were smoker and 7(21%) patients had family history of Ischaemic heart disease. Female patients were more obese (BMI M 26: F 27) and developed coronary artery diseases in advance age. Common stented territory were left main: 20 (60%), Left main to left anterior descending artery 7 (22%) and Left main to left circumflex artery 6 (18%). Average length and diameter of stent was 3.5 and 18 mm respectively. Stent used: Bare Metal Stent 5 (15%), Drug Eluting Stent: 28 (85%). Among the different Drug Eluting Stents, Everolimus eluting stents were 11 (39.3%), Sirolimus eluting 10(35.7%), Paclitaxel eluting 3 (10.7%), Biolimus eluting 3 (10.7%) and Zotarolimus eluting1 (3.6%). In the present study, overall survival outcome was 94% (31 patient), mortality of cardiac cause 3% (1 patient) and 1 patient (3%) died of hepatocellular carcinoma. Conclusion: Our study has shown that percutaneous coronary intervention of the unprotected left main is a safe and effective alternative to Coronary Artery Bypass Graft (CABG). DOI: http://dx.doi.org/10.3329/cardio.v6i2.18349 Cardiovasc. j. 2014; 6(2): 107-111

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“…There is renewed interest in LM-PCI because of improved outcomes of PCI utilizing drug eluting stents (DES) in multiple randomized trials. Several single-center non-randomized registries [1][2][3] have evaluated the role of DES for LM-PCI. Data suggest a low mortality and target vessel failure of ostial LM or mid-shaft lesions in contrast to bifurcation lesions, which frequently require complex dual stenting techniques.…”

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confidence: 99%

Conundrum: intervention for unprotected left main bifurcation coronary lesions

Fukuzawa

2010

Cardiovasc Interv and Ther

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Percutaneous coronary intervention (PCI) of the unprotected left main (LM) artery is currently not recommended as a routine procedure based on the history of inferior outcomes of LM percutaneous transluminal coronary angioplasty and bare metal stenting. Instead, surgical revascularization coronary artery bypass grafting (CABG) is considered to be the gold standard. There is renewed interest in LM-PCI because of improved outcomes of PCI utilizing drug eluting stents (DES) in multiple randomized trials. Several single-center non-randomized registries [1][2][3] have evaluated the role of DES for LM-PCI. Data suggest a low mortality and target vessel failure of ostial LM or mid-shaft lesions in contrast to bifurcation lesions, which frequently require complex dual stenting techniques. Actually, the treatment of lesions at LM bifurcations remains a technical challenge. Interventions at these sites are associated not only with a high risk of acute temporal deterioration of coronary flow but definitive loss of one of the distal large branches may also occur.The recently reported SYNTAX trial [4] utilized several important design features which made these results the most relevant information available to guide the management of patients with advanced coronary artery disease (CAD). SYNTAX was a large prospective randomized controlled trial (RCT) for patients with three-vessel or LM (or combined) CAD. Its clinical importance is enhanced by its multicenter design and the enrollment of ''all comers''.Patients eligible for randomization were those in whom a consensus was reached by an interdisciplinary team of interventional cardiologists and cardiothoracic surgeons that equivalent revascularization could be achieved with either therapeutic option. Subjects were prospectively stratified by diabetic status and the presence or absence of LM disease. In LM substudy, major adverse cardiac and cerebrovascular event (MACCE) rates at 1 year were similar for CABG and PCI (13.7 vs. 15.8%, P = 0.44). At 1 year, stroke was significantly higher in the CABG arm (2.7 vs. 0.3%, P = 0.009), whereas repeat revascularization was significantly higher in the PCI arm (6.5 vs. 11.8%, P = 0.02); there was no observed difference between groups for other end points. As this result, PCI to the LM disease to a morbid state became Class IIB from Class III in the guideline. However, it is short-circuited to conclude that only PCI can treat all the patients with LM disease. In the important point that should be noted with SYNTAX, there are 1077 examples (25%) who are judged to be an adjustment of CABG of all examples. In contrast, it is only 198 examples that were deemed suitable only for PCI. It is only 59% that was randomized after all, and 35% of the case of the whole is assumed that the risk of PCI is high and registered in CABG registry. Going forward, insights into the selection of patients with LM or multivessel disease who can be optimally managed with PCI was provided by the SYNTAX score. The SYNTAX score was designed to reflect the complexity ...

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Two-Year Clinical Outcome With Drug-Eluting Stents Versus Bare-Metal Stents in a Real-World Registry of Unprotected Left Main Coronary Artery Stenosis from the Italian Society of Invasive Cardiology

Cited by 58 publications

References 20 publications

Seguimiento a largo plazo tras el tratamiento percutáneo del tronco coronario izquierdo no protegido en pacientes de alto riesgo no aptos para cirugía de revascularización

Seguimiento a largo plazo tras el tratamiento percutáneo del tronco coronario izquierdo no protegido en pacientes de alto riesgo no aptos para cirugía de revascularización

Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention-Our Experiences at a Tertiary Hospital

Conundrum: intervention for unprotected left main bifurcation coronary lesions

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