title: 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.
abstract: 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.
authors.affiliation: Istituto di Cardiologia, Policlinico S Orsola, Università di Bologna, Policlinico S Orsola, 40 138 Bologna, Italy. tulliopalmerini@hotmail.com
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Diego
authors.initials: D
authors.lastname: Sangiorgi
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Massimo
authors.initials: M
authors.lastname: Margheri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vecchi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: Michele
authors.initials: M
authors.lastname: Ruffini
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: 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
mesh_terms: 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