Ostial and midshaft lesions vs. bifurcation lesions in 1111 patients with unprotected left main coronary artery stenosis treated with drug-eluting stents: results of the survey from the Italian Society of Invasive Cardiology.
OBJECTIVE
In this study, we compared the cumulative risk of major adverse cardiac events (MACE) of patients with distal unprotected left main coronary artery (ULMCA) stenosis with those of patients with ostial and midshaft lesions treated with drug-eluting stent (DES).


RESULTS
The survey promoted by the Italian Society of Invasive Cardiology on ULMCA stenosis was an observational study involving 19 high-volume Italian centres. We enrolled 1111 patients with ULMCA stenosis treated with DES. Major adverse cardiac events were defined as death, myocardial infarction, and target lesion revascularization. Three hundred and thirty-four patients had ostial or midshaft lesions (group 1) and 777 bifurcations (group 2). The adjusted hazards ratio of the risk of 2 year MACE of patients in group 2 vs. patients in group 1 was 1.50 (P = 0.024). However, we observed that there was a significant difference between patients with bifurcations treated with two stents and those in group 1 (P = 0.001), but not between patients with bifurcations treated with one stent and those in group 1 (P = 0.38).


CONCLUSIONS
Patients with bifurcations have a worse outcome than patients with ostial and midshaft lesions. However, the technique used to treat bifurcations has a significant impact on clinical outcomes.
Palmerini
Tullio
T
Istituto di Cardiologia, Policlinico S Orsola, Università di Bologna, Policlinico S Orsola, 40 138 Bologna, Italy. tulliopalmerini@hotmail.com
Sangiorgi
Diego
D
Marzocchi
Antonio
A
Tamburino
Corrado
C
Sheiban
Imad
I
Margheri
Massimo
M
Vecchi
Giuseppe
G
Sangiorgi
Giuseppe
G
Ruffini
Michele
M
Bartorelli
Antonio L
AL
Briguori
Carlo
C
Vignali
Luigi
L
Di Pede
Francesco
F
Ramondo
Angelo
A
Inglese
Luigi
L
De Carlo
Marco
M
Bolognese
Leonardo
L
Benassi
Alberto
A
Palmieri
Cataldo
C
Filippone
Vincenzo
V
Barlocco
Fabio
F
Lauria
Giulia
G
De Servi
Stefano
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023921:Coronary Stenosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D054855:Drug-Eluting Stents; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization / Q000401:mortality; D016896:Treatment Outcome