title: 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.
abstract: 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.
authors.affiliation: Cardiological Department, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China. chmengx@126.com
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.forename: Jun-jie
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Zhi-zhong
authors.initials: ZZ
authors.lastname: Liu
authors.forename: Song
authors.initials: S
authors.lastname: Lin
authors.forename: Zhong-Sheng
authors.initials: ZS
authors.lastname: Zhu
authors.forename: Xue-wen
authors.initials: XW
authors.lastname: Sun
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.forename: Ai-ping
authors.initials: AP
authors.lastname: Zhang
authors.forename: Jin-guo
authors.initials: JG
authors.lastname: Chen
authors.forename: Qing-jiong
authors.initials: QJ
authors.lastname: Ji
authors.forename: Jun
authors.initials: J
authors.lastname: Qian
authors.forename: Feng
authors.initials: F
authors.lastname: Chen
authors.forename: Tak W
authors.initials: TW
authors.lastname: Kwan
mesh_terms: 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