title: Impact of lesion morphology and associated procedures for left main coronary stenting on angiographic outcome after intervention: sub-analysis of Heart Research Group of Kanazawa, HERZ, Study.
abstract: Whether the lesion morphology and associated interventional procedures for the left main coronary artery disease (LMCA) could affect clinical outcome is still controversial. Therefore, we examined the impact of lesion morphology and associated procedures on clinical and angiographic outcomes of stenting for the LMCA. Among 7,660 patients with coronary intervention registered, we analyzed early angiographic results of 228 patients (179 men, mean age 69.4 years) concerned with LMCA lesions. In 121 out of 228 patients having long-term angiographic results, we examined the occurrence of major adverse coronary events (MACE) particularly in terms of the presence of acute coronary syndrome (ACS), the kind of stents, bear metal or drug eluting, the lesion morphology and associated procedures. Early angiographic success rate of LMCA stenting was 100 %, and clinical success rate was 94.3 %. During follow-up period for 3 years, MACE was observed in 17 patients. Under these conditions, multiple stenting (p < 0.01) and complicated procedures such as such as Y-stent, T-stent and crush stent (p < 0.01) were listed as risks for MACE, although there was no statistical difference in kinds of stent. Multivariate analysis demonstrated the significant disadvantage of complicated procedures using the bear metal stent on the occurrence of MACE (p < 0.01). These results demonstrate that the complicated procedures have great impact on clinical and angiographic outcomes after stenting for LMCA lesions, and suggest the simple procedure with a single stent for LMCA lesions in the present cohort. Whether the presence of ACS can affect the prognosis should further be sought.
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Masa-aki
authors.initials: MA
authors.lastname: Kawashiri
authors.forename: Kenji
authors.initials: K
authors.lastname: Sakata
authors.forename: Katsuharru
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Konno
authors.forename: Masanobu
authors.initials: M
authors.lastname: Namura
authors.forename: Sumio
authors.initials: S
authors.lastname: Mizuno
authors.forename: Ryozo
authors.initials: R
authors.lastname: Tatami
authors.forename: Honin
authors.initials: H
authors.lastname: Kanaya
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nitta
authors.forename: Ichiro
authors.initials: I
authors.lastname: Michishita
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hirase
authors.forename: Kosei
authors.initials: K
authors.lastname: Ueda
authors.forename: Takashi
authors.initials: T
authors.lastname: Aoyama
authors.forename: Kazuyasu
authors.initials: K
authors.lastname: Okeie
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Haraki
authors.forename: Kiyoo
authors.initials: K
authors.lastname: Mori
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Araki
authors.forename: Masaharu
authors.initials: M
authors.lastname: Minamoto
authors.forename: Hisanori
authors.initials: H
authors.lastname: Oiwake
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Ino
authors.forename: Kenshi
authors.initials: K
authors.lastname: Hayashi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamagishi
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome