Distal left main coronary bifurcation lesions predict worse outcome in patients undergoing percutaneous implantation of drug-eluting stents: results from the Drug-Eluting Stent for the Treatment of Left Main Disease (DISTAL) Study.
OBJECTIVE
We investigated the clinical outcome of stenting of unprotected left main coronary artery (LMCA).


METHODS
We studied 164 patients with nonbifurcated LMCA lesions (group A) and 96 patients with distal bifurcated lesions (group B).


RESULTS
Clinical follow-up was available in 100%. Angiographic follow-up was 87.3% in group A and 86% in group B (p = 0.922). There were significant differences in major adverse cardiac events at 1 (p = 0.014) and 2 years (p = 0.002) between group B (19.8%, 25.0%) and group A (9.1%, 10.4%), mainly due to increased target-vessel revascularization (16.7, 21.9% in group B vs. 6.1, 7.3% in group A, p = 0.006 and 0.001, respectively). The double-stent technique was associated with worse outcomes at 1 year in group B compared to group A. Bifurcation lesions (HR 3.42, 95% CI 1.34-5.61, p = 0.001), diabetes (HR 2.68, 95% CI 2.01-12.11, p = 0.015), three-vessel disease (HR 0.83, 95% CI 0.27-0.96, p = 0.001), incomplete revascularization (HR 0.15, 95% CI 0.11-0.35, p = 0.001) and stent diameter (HR 5.05, 95% CI 2.71-10.01, p = 0.03) were the independent factors of major adverse cardiac events in the whole patient cohort.


CONCLUSIONS
Stenting unprotected distal bifurcated LMCA was associated with unfavorable results when compared to stenting other LMCA lesions.
Chen
Shao-Liang
SL
Cardiological Department, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China. chmengx@126.com
Ye
Fei
F
Zhang
Jun-jie
JJ
Liu
Zhi-zhong
ZZ
Lin
Song
S
Zhu
Zhong-Sheng
ZS
Sun
Xue-wen
XW
Li
Feng
F
Zhang
Ai-ping
AP
Chen
Jin-guo
JG
Ji
Qing-jiong
QJ
Qian
Jun
J
Chen
Feng
F
Kwan
Tak W
TW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013318:Stroke Volume; D017211:Treatment Failure; D016896:Treatment Outcome