title: Impact of routine angiographic follow-up after percutaneous coronary drug-eluting stenting for unprotected left main disease: the Turin Registry.
abstract: BACKGROUND
  Most cardiologists performing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main disease (ULM) mandate mid-term angiographic follow-up, yet there are few data supporting this approach. We aimed to retrospectively compare the outcome of patients with ULM treated with DES according to their follow-up management strategy.
  
  
  METHODS
  Patients with ULM stenosis undergoing PCI with DES and surviving up to 6 months were retrospectively identified from our ongoing database. We distinguished those undergoing clinical follow-up only, those with clinically driven angiographic follow-up, and those with routine angiographic follow-up. The primary end-point was the long-term rate of major adverse cardiac events (MACE, i.e., death, myocardial infarction, bypass surgery, or repeat ULM PCI).
  
  
  RESULTS
  A total of 198 patients were included: 55 (28%) in the clinical follow-up group, 64 (32%) in the clinically driven angiographic follow-up group, and 79 (40%) in the routine angiographic follow-up group. After 37.0 +/- 15.7 months, mortality was similar in the 3 groups (respectively 7.3, 4.7, and 5.9%, p = 0.27). However, MACE were significantly more common in the clinically driven angiographic follow-up group (42.2 vs. 7.3 and 26.1%, p = 0.02), mainly due to the expected increase in repeat revascularization in those undergoing angiographic follow-up (23.4 vs. 1.8 and 13.14%). Notably, there were no differences in the rate of stent thrombosis across the three groups, with rates of 3.1 vs. 1.8 and 2.5% (p = 0.35).
  
  
  CONCLUSIONS
  An expectant management can be safely adopted in most patients with ULM treated percutaneously, as long as a low threshold for control coronary angiography is maintained.
authors.affiliation: S. Giovanni Battista "Molinette" Hospital, University of Turin, Italy. gbiondizoccai@gmail.com
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Elena
authors.initials: E
authors.lastname: Giraudi
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Filippo
authors.initials: F
authors.lastname: Sciuto
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.forename: Dario
authors.initials: D
authors.lastname: Sillano
authors.forename: Paolo
authors.initials: P
authors.lastname: Garrone
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Trevi
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000628:therapy*; D023921:Coronary Stenosis / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome