title: Long-term clinical outcomes following drug-eluting stent implantation for unprotected distal trifurcation left main disease: the Milan-New Tokyo (MITO) registry.
abstract: BACKGROUND
  Unprotected distal left main trifurcation (ULMT) lesion represents a challenge for interventional cardiologists with the potential for peri-procedural complications and adverse events at follow-up especially when the main branch and the side branches are concomitantly diseased.
  
  
  METHODS
  A retrospective cohort analysis was performed on consecutive patients with ULMT stenosis who electively underwent percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation in order to assess the technical feasibility and long-term outcomes according to the disease distribution in the trifurcation branches (true vs. non-true ULMT). Primary endpoint of the study was a composite of major adverse cardiovascular events (MACE) defined as cardiac-death, myocardial infarction (MI), and target lesion revascularization (TLR) during follow-up.
  
  
  RESULTS
  Eighty-four patients underwent PCI with DES for ULMT disease during the study period (40 true trifurcation and 44 non-true trifurcation). Angiographic and procedural success were obtained in 94% and 92.8% of cases. At 3-years follow-up, the occurrence of MACE was significantly higher in patients with true ULMT than in those with non-true ULMT (HR 2.801 [confidence interval; CI 1.164-7.896], P = 0.025) due to a higher TLR rate (HR 3.032 [CI 1.164-7.896], P = 0.023). No episodes of late and very late definite/probable stent thrombosis (ST) occurred. On multivariable analysis, a true-ULMT lesion was the only independent predictor of MACE (HR 2.344 [C.I. 1.006-5.461], P = 0.049).
  
  
  CONCLUSIONS
  PCI with DES for ULMT stenosis is feasible with a high procedural success rate and no definite/probable ST reported at follow-up. A true trifurcation lesion is associated with enhanced risk of MACE mainly driven by TLR.
authors: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors: Alfonso
authors: A
authors: Ielasi
authors: Kensuke
authors: K
authors: Takagi
authors: Azeem
authors: A
authors: Latib
authors: Sandeep
authors: S
authors: Basavarajaiah
authors: Filippo
authors: F
authors: Figini
authors: Mauro
authors: M
authors: Carlino
authors: Matteo
authors: M
authors: Montorfano
authors: Alaide
authors: A
authors: Chieffo
authors: Sunao
authors: S
authors: Nakamura
authors: Antonio
authors: A
authors: Colombo
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: angioplasty; complex; coronary artery disease