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Original Articles

Impact of Bifurcation Technique on 2-Year Clinical Outcomes in 773 Patients With Distal Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents

Tullio Palmerini, MD; Antonio Marzocchi, MD; Corrado Tamburino, MD; Imad Sheiban, MD; Massimo Margheri, MD; Giuseppe Vecchi, MD; Giuseppe Sangiorgi, MD; Andrea Santarelli, MD; Antonio Bartorelli, MD; Carlo Briguori, MD, PhD; Luigi Vignali, MD; Francesco Di Pede, MD; Angelo Ramondo, MD; Luigi Inglese, MD; Marco De Carlo, MD; Giovanni Falsini, MD; Alberto Benassi, MD; Cataldo Palmieri, MD; Vincenzo Filippone, MD; Diego Sangiorgi, MSc; Fabio Barlocco, MD and Stefano De Servi, MD

From the Istituto di Cardiologia (T.P., A.M., D.S.), Policlinico S. Orsola, Università di Bologna, Italy; Dipartimento di Cardiologia (C.T.), Ospedale Ferrarotto, Università di Catania, Italy; Divisione di Cardiologia (I.S.), Università di Torino, Italy; Dipartimento Cardiovascolare (M.M.), Ospedale Careggi, Università di Firenze, Italy; Dipartimento di Cardiologia (G.V.), Ospedale S. Maria delle Croci, Ravenna, Italy; Centro Emocolumbus (G.S.), Milano, Italy; Dipartimento di Cardiologia (A.S.), Ospedale degli Infermi, Rimini, Italy; Centro Cardiologico Monzino (A.B.), Milano, Italy; Dipartimento di Cardiologia (C.B.), Clinica Mediterranea, Napoli, Italy; Unità Operativa di Cardiologia (L.V.), Azienda Ospedaliero-Universitaria, Parma, Italy; Dipartimento di Cardiologia (F.D.P.), Azienda Ospedaliera. Mestre; Italy; Dipartimento di Scienze Cardiovascolari (A.R.), Università di Padova, Italy; Cardiovascular Interventional Radiology Department (L.I.), IRCCS Policlinico S. Donato, S. Donato Milanese, Italy; Dipartimento Cardio-Toracico (M.D.C.), Ospedale Cisanello, Pisa, Italy; Dipartimento Cardiovascolare (G.F.), Ospedale S. Donato, Arezzo, Italy; Dipartimento di Cardiologia (A.B.), Hesperia Hospital, Modena, Italy; Istituto Fisiologia Clinica (A.P.), CNR, Massa, Italy; Dipartimento Cardiovascolare (V.F.), Ospedale Cervello, Palermo, Italy; Dipartimento di Malattie Cardiovascolari (F.B., S.D.S.), Ospedale Civile, Legnano, Italy.

Correspondence to Tullio Palmerini, Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola, Via Massarenti 9, 40 138 Bologna, Italy. E-mail tulliopalmerini{at}hotmail.com

Received June 19, 2008; accepted September 30, 2008.

Background— Distal unprotected left main coronary artery (ULMCA) stenosis represents a technical challenge for interventional cardiologists. In this study, we compared 2-year clinical outcomes of different stenting strategies in patients with distal ULMCA stenosis treated with drug-eluting stents.

Methods and Results— The survey promoted by the Italian Society of Invasive Cardiology on ULMCA stenosis was an observational study on patients with ULMCA stenosis treated with percutaneous coronary intervention. In this study, we selected patients with distal ULMCA stenosis treated with drug-eluting stents. Seven hundred seventy-three patients were eligible for this study: 456 were treated with 1 stent (group 1) and 317 with 2 stents (group 2). The primary end point of the study was the incidence of major adverse cardiac events (MACEs), defined as the occurrence of mortality, myocardial infarction, and target lesion revascularization. During a 2-year follow-up, risk-adjusted survival free from MACE was significantly higher in patients in group 1 than in patients in group 2. The propensity-adjusted hazard ratio for the risk of 2-year MACE in patients in group 1 versus group 2 was 0.53 (95% CI, 0.37 to 0.76). The propensity-adjusted hazard ratio for the risk of 2-year cardiac mortality and myocardial infarction in patients in group 1 versus group 2 was 0.38 (95% CI, 0.17 to 0.85).

Conclusions— Compared with the 2-stent technique, the 1-stent technique is associated with a better 2-year MACE-free survival. The stenting strategy is a prognostic factor that should be taken into account when deciding the optimal revascularization treatment.

Key Words: mortality • restenosis • stents

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CLINICAL PERSPECTIVE

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Impact of Bifurcation Technique on 2-Year Clinical Outcomes in 773 Patients With Distal Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents

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