title: Impact of stenting technique and bifurcation anatomy on long-term outcomes of PCI for distal unprotected left main coronary disease.
abstract: OBJECTIVE
  We aimed to assess the associations of stenting strategy and bifurcation anatomy with outcomes of percutaneous coronary intervention (PCI) for distal unprotected left main (ULM) coronary disease.
  
  
  BACKGROUND
  There are limited and conflicting data regarding long-term outcomes associated with stenting strategies for PCI of distal ULM coronary disease.
  
  
  METHODS
  Patients undergoing non-emergent PCI for distal ULM coronary disease comprised the study cohort. Baseline characteristics and outcomes including cardiac death, cardiac death or myocardial infarction (MI), and overall major adverse cardiac events (MACEs) were compared for patients undergoing single-vessel stenting (SVS) versus bifurcation stenting (BS).
  
  
  RESULTS
  Seventy patients underwent treatment of distal ULM coronary disease with PCI. Drug-eluting stents (DESs) were used in 96% and 32 (46%) had BS. Patients undergoing SVS vs BS had more severe disease involving the left circumflex artery. Patients with BS were more likely to experience cardiac death and MI (hazard ratio [HR] 3.5; 95% confidence interval [CI], 1.1-11.1; P=.04) or combined MACE (HR, 4.2; 95% CI, 1.8-10.2; P=.001). After adjusting for angiographic characteristics of the bifurcation in Cox proportional hazards models, BS remained a significant predictor of MACE.
  
  
  CONCLUSIONS
  In this unselected series of patients undergoing PCI for distal left main disease, a single-vessel stenting strategy was associated with superior long-term outcomes after accounting for angiographic characteristics of the bifurcation. Future studies need to take into account additional factors to clarify the ideal treatment strategy for distal left main disease.
authors.affiliation: Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, 4/floor, 2200 O'Farrell Street, San Francisco, CA 94115 USA. ngwlsrc@gmail.com
authors.forename: William
authors.initials: W
authors.lastname: Ng
authors.forename: Robert
authors.initials: R
authors.lastname: Lundstrom
authors.forename: Edward
authors.initials: E
authors.lastname: McNulty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome