title: A prospective multicentre observational study on the management of unprotected left main coronary artery disease: rationale and design of the Registro Italiano sul Trattamento del tronco comune non protetto study.
abstract: BACKGROUND
  The optimal approach for a significant unprotected left main coronary stenosis is debated in light of the recent progresses of percutaneous coronary intervention. However, bypass surgery is still considered the first choice treatment. Randomized trials comparing percutaneous intervention and bypass grafting are ongoing, yet patient selection will limit their applicability. We designed a prospective multicentre registry, which will include patients with unprotected left main disease independent of the subsequent medical, interventional or surgical treatment.
  
  
  OBJECTIVE
  The aim of this study is to evaluate prospectively the prevalence, treatment, and prognosis of patients with unprotected left main stenosis.
  
  
  METHODS
  More than 30 Italian care centres will participate. Patients with unprotected left main stenosis will be enrolled, excluding those with only mild atherosclerotic irregularities or patent grafts. The primary endpoint will be the 12-month occurrence of major adverse cardiac and cerebral events (MACCE, i.e. the composite of death, non-fatal myocardial infarction, stroke, or coronary revascularization by percutaneous intervention or bypass surgery). Secondary endpoints will be the occurrence of individual components of the primary endpoint at 1, 6, 24, and 60 months, the rate of major adverse cardiac and cerebral events without stroke, functional class, and quality of life. Analyses will be stratified according to lesion severity, as well as other patient, lesion, and procedural characteristics. EXPECTED RESULTS AND IMPLICATIONS: This multicentre prospective registry of patients with unprotected left main coronary stenosis treated medically, percutaneously or surgically will provide important and updated data on the prevalence, therapeutic choices, and prognosis of this important patient population.
authors.affiliation: Division of Cardiology, University of Turin, Turin, Italy. isheiban@yahoo.com
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Dario
authors.initials: D
authors.lastname: Sillano
authors.forename: Giuseppe Gl
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Trevi
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome