title: Temporal pattern of ischemic events in relation to dual antiplatelet therapy in patients with unprotected left main coronary artery stenosis undergoing percutaneous coronary intervention.
abstract: OBJECTIVE
  The aim of this study was to investigate whether there is a temporal pattern of ischemic events in relation to dual antiplatelet therapy in patients with unprotected left main coronary artery (ULMCA) stenosis treated with percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Identifying which periods during follow-up of patients with ULMCA stenosis treated with PCI are associated with higher risk of clinical events might help to improve therapeutic strategies.
  
  
  METHODS
  We analyzed data from 15 centers involved in an observational study conducted by the Italian Society of Invasive Cardiology on patients with ULMCA stenosis treated with PCI. Eight hundred ninety-four patients were enrolled.
  
  
  RESULTS
  At 30-day follow-up, the rate of cardiac mortality and myocardial infarction (MI) was 5.4%. In patients still taking dual antiplatelet therapy, the adjusted incidence rate ratio/10,000 patient-days of the combination of cardiac mortality and MI in the 31- to 180-day interval compared with the 181- to 360-day interval after PCI was 3.64 (p = 0.035). This risk was particularly high in patients with acute coronary syndromes. After stopping clopidogrel, the adjusted incidence rate ratio of cardiac mortality and MI in the 0- to 90-day interval compared with the 91- to 180-day interval was 4.20 (p = 0.009).
  
  
  CONCLUSIONS
  In patients with ULMCA stenosis taking dual antiplatelet therapy there is an increased hazard of cardiac mortality and MI between 31 and 180 days compared with 181 to 360 days. Furthermore, there is an increased hazard of cardiac mortality and MI in the first 90 days after stopping clopidogrel.
authors.affiliation: Istituto di Cardiologia, Policlinico S. Orsola, Università di Bologna, Bologna, Italy. tulliopalmerini@hotmail.com
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Imad
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authors.lastname: Sheiban
authors.forename: Massimo
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authors.lastname: Margheri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vecchi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: Andrea
authors.initials: A
authors.lastname: Santarelli
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Luigi
authors.initials: L
authors.lastname: Vignali
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Pede
authors.forename: Angelo
authors.initials: A
authors.lastname: Ramondo
authors.forename: Luigi
authors.initials: L
authors.lastname: Inglese
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
authors.forename: Alberto
authors.initials: A
authors.lastname: Benassi
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Filippone
authors.forename: Diego
authors.initials: D
authors.lastname: Sangiorgi
authors.forename: Fabio
authors.initials: F
authors.lastname: Barlocco
authors.forename: Giulia
authors.initials: G
authors.lastname: Lauria
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi