title: Impact of bifurcation technique on 2-year clinical outcomes in 773 patients with distal unprotected left main coronary artery stenosis treated with drug-eluting stents.
abstract: BACKGROUND
  Distal unprotected left main coronary artery (ULMCA) stenosis represents a technical challenge for interventional cardiologists. In this study, we compared 2-year clinical outcomes of different stenting strategies in patients with distal ULMCA stenosis treated with drug-eluting stents.
  
  
  RESULTS
  The survey promoted by the Italian Society of Invasive Cardiology on ULMCA stenosis was an observational study on patients with ULMCA stenosis treated with percutaneous coronary intervention. In this study, we selected patients with distal ULMCA stenosis treated with drug-eluting stents. Seven hundred seventy-three patients were eligible for this study: 456 were treated with 1 stent (group 1) and 317 with 2 stents (group 2). The primary end point of the study was the incidence of major adverse cardiac events (MACEs), defined as the occurrence of mortality, myocardial infarction, and target lesion revascularization. During a 2-year follow-up, risk-adjusted survival free from MACE was significantly higher in patients in group 1 than in patients in group 2. The propensity-adjusted hazard ratio for the risk of 2-year MACE in patients in group 1 versus group 2 was 0.53 (95% CI, 0.37 to 0.76). The propensity-adjusted hazard ratio for the risk of 2-year cardiac mortality and myocardial infarction in patients in group 1 versus group 2 was 0.38 (95% CI, 0.17 to 0.85).
  
  
  CONCLUSIONS
  Compared with the 2-stent technique, the 1-stent technique is associated with a better 2-year MACE-free survival. The stenting strategy is a prognostic factor that should be taken into account when deciding the optimal revascularization treatment.
authors.affiliation: Istituto di Cardiologia, Policlinico S. Orsola, Università di Bologna, Via Massarenti 9, 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
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: Andrea
authors.initials: A
authors.lastname: Santarelli
authors.forename: Antonio
authors.initials: A
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: Giovanni
authors.initials: G
authors.lastname: Falsini
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: Stefano
authors.initials: S
authors.lastname: De Servi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D019233:Retreatment; D012189:Retrospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left