Long‐term clinical outcomes following drug‐eluting stent implantation for unprotected distal trifurcation left main disease: The Milan‐New Tokyo (MITO) registry. Issue 4 (30th September 2013)

• Record Type: Journal Article
• Authors: Ielasi, Alfonso; Takagi, Kensuke; Latib, Azeem; Basavarajaiah, Sandeep; Figini, Filippo; Carlino, Mauro; Montorfano, Matteo; Chieffo, Alaide; Nakamura, Sunao; Colombo, Antonio
• Is Part Of: Catheterization and cardiovascular interventions. Volume 83:Issue 4(2014:Mar. 01)
• Page Start: 530
• Page End: 538
• Publication Date: 2013-09-30
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25174
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25174-sec-0001" sec-type="section"> <title>Background</title> <p>Unprotected distal left main trifurcation (ULMT) lesion represents a challenge for interventional cardiologists with the potential for peri‐procedural complications and adverse events at follow‐up especially when the main branch and the side branches are concomitantly diseased.</p> </sec> <sec id="ccd25174-sec-0002" sec-type="section"> <title>Methods</title> <p>A retrospective cohort analysis was performed on consecutive patients with ULMT stenosis who electively underwent percutaneous coronary intervention (PCI) with drug‐eluting stent (DES) implantation in order to assess the technical feasibility and long‐term outcomes according to the disease distribution in the trifurcation branches (true vs. non‐true ULMT). Primary endpoint of the study was a composite of major adverse cardiovascular events (MACE) defined as cardiac‐death, myocardial infarction (MI), and target lesion revascularization (TLR) during follow‐up.</p> </sec> <sec id="ccd25174-sec-0003" sec-type="section"> <title>Results</title> <p>Eighty‐four patients underwent PCI with DES for ULMT disease during the study period (40 true trifurcation and 44 non‐true trifurcation). Angiographic and procedural success were obtained in 94% and 92.8% of cases. At 3‐years follow‐up, the occurrence of MACE was significantly higher in patients with true ULMT than in those with non‐true ULMT (HR 2.801 [confidence interval; CI 1.164–7.896], <italic>P</italic> = 0.025) due to a higher TLR rate (HR 3.032 [CI 1.164–7.896], <italic>P</italic> = 0.023). No episodes of late and very late definite/probable stent thrombosis (ST) occurred. On multivariable analysis, a true‐ULMT lesion was the only independent predictor of MACE (HR 2.344 [C.I. 1.006–5.461], <italic>P</italic> = 0.049).</p> </sec> <sec id="ccd25174-sec-0004" sec-type="section"> <title>Conclusions</title> <p>PCI with DES for ULMT stenosis is feasible with a high procedural success rate and no definite/probable ST reported at follow‐up. A true trifurcation lesion is associated with enhanced risk of MACE mainly driven by TLR. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>