title: Impact of residual chronic total occlusion of right coronary artery on the long-term outcome in patients treated for unprotected left main disease: the Milan and New-Tokyo registry.
abstract: BACKGROUND
  The presence of chronic total occlusion of the right coronary artery (CTO-RCA) in patients undergoing percutaneous interventions for unprotected left main (ULM) disease may affect the prognosis. In this study, we evaluated the immediate results and follow-up of patients with ULM-percutaneous interventions and with or without associated CTO-RCA.
  
  
  RESULTS
  Between March 2002 and December 2008, a total of 568 consecutive patients with ULM stenosis treated with drug-eluting stent were included in this analysis. The mean EuroScore and SYNTAX scores were 4.05±2.62 and 28.12±10.82, respectively. Of these, 522 had ULM lesions without residual CTO-RCA (493 ULM without CTO-RCA+29 ULM with treated CTO-RCA), and 46 patients had residual CTO-RCA. At 1466 days (interquartile range, 1150-1917) follow-up, the cardiac-death occurred in 41 patients (7.2%). Cardiac-death was more frequently observed in patients with ULM and residual CTO-RCA as compared with those without residual CTO-RCA (adjusted hazard ratios, 2.163 [95% confidence interval, 1.018-4.597]; P=0.045). However, target lesion revascularization occurred less frequently in patients with residual CTO-RCA (adjusted hazard ratios, 0.321 [95% confidence interval, 0.13-0.794]; P=0.014), resulting in the similar major adverse cardiovascular events rates between the 2 groups. When we analyzed patients with concomitant ULM and CTO-RCA, cardiac-death was significantly higher in patients with residual as compared with treated CTO-RCA (log-rank P=0.01) despite no difference in baseline characteristics.
  
  
  CONCLUSIONS
  Cardiac-death occurred more frequently in patients with residual CTO-RCA as compared with those without residual CTO-RCA. These findings suggest that recanalization of CTO-RCA has significant impact on the long-term cardiac-mortality in patients undergoing ULM-percutaneous interventions probably by offering reserve coronary circulation, if in-stent restenosis were to occur in the treated left main.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ielasi
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Sandeep
authors.initials: S
authors.lastname: Basavarajaiah
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mizuno
authors.forename: Tasuku
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.forename: Joanne
authors.initials: J
authors.lastname: Shannon
authors.forename: Ahmed
authors.initials: A
authors.lastname: Rezq
authors.forename: Santo
authors.initials: S
authors.lastname: Ferrarello
authors.forename: Chiara
authors.initials: C
authors.lastname: Bernelli
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujino
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D002908:Chronic Disease; D003326:Coronary Circulation; D023903:Coronary Restenosis / Q000401:mortality*; D023921:Coronary Stenosis / Q000401:mortality* / Q000628:therapy*; D003331:Coronary Vessels; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D050257:Tubulin Modulators / Q000008:administration & dosage
chemical_list: D050257:Tubulin Modulators; D017239:Paclitaxel