Prediction of clinical outcomes in patients with unprotected left main trifurcation lesions treated by drug-eluting stents: importance of 2-stent technique and SYNTAX score.
BACKGROUND
There were insufficient data on the prognosis of stenting for patients with trifurcated unprotected left main lesions (UPLMS).


METHODS
From the SPEED (stents for percutaneous treatment of coronary artery disease) registry of all percutaneous coronary interventions (PCI) for all types of UPLMS, data of 44 patients with trifurcated UPLMS were selected and analyzed.


RESULTS
Patients were divided into one-stent (N = 23) or 2-stent (N = 21) groups. Clinical follow-up was available for 100%, and angiographic follow-up at 8 month was available for 91.3%. There were no differences in myocardial infarction, cardiac death, and stent thrombosis between groups. However, the target lesion revascularization (TLR) and target vessel revascularization (TVR) in the 1-stent group was lower when compared to the 2-stent group (13.0% vs. 23.8%, P = 0.004; 13.0% vs. 28.6%, P = 0.003, respectively). Cumulative survival free from major adverse cardiovascular events (MACE) in the 1-stent group was higher than the 2-stent group (65.2% vs. 57.1%, P = 0.033). Analysis of the receiver operator curve (ROC) of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score showed the area under the curve was 0.414 (standard error = 0.089, 95% CI 0.240-0.589, P = 0.348).


CONCLUSIONS
In patients with trifurcated UPLMS, higher TLR/TVR and lower cumulative survival from MACE were seen in the 2-stent group when compared to the 1-stent group. The SYNTAX scoring system had no predictive value of outcomes for patients with stenting of trifurcated UPLMS.
Chen
Shao-Liang
SL
Cardiological Department, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China. chmengx@126.com
Ye
Fey
F
Zhang
Jun-Jie
JJ
Hu
Zuo-Ying
ZY
Tian
Nai-Liang
NL
Zhang
Jun-Xia
JX
Kwan
Tak W
TW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000628:therapy*; D023921:Coronary Stenosis / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D012372:ROC Curve; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume