title: Long-term clinical outcomes after percutaneous coronary intervention for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery: the DELTA Registry (drug-eluting stent for left main coronary artery disease): a multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment.
abstract: OBJECTIVE
  The aim of this study was to compare, in a large all-comer registry, the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery (ULMCA) stenosis.
  
  
  BACKGROUND
  Limited data are available regarding clinical outcomes following DES implantation at the different ULMCA sites.
  
  
  METHODS
  Patients with ULMCA stenosis treated by PCI with DES were analyzed in this multinational registry.
  
  
  RESULTS
  A total of 1,612 patients were included: 482 were treated for ostial/mid-shaft lesions versus 1,130 for distal bifurcation lesions. At a median follow-up period of 1,250 (interquartile range: 987 to 1,564) days, PCI for distal bifurcation lesions was associated with a higher incidence of major adverse cardiac events (propensity-score adjusted hazard ratio [HR]: 1.48, 95% confidence interval [CI]: 1.16 to 1.89; p = 0.001), largely because of the higher target vessel revascularization rate observed in this group as compared to the ostial/mid-shaft lesions group (propensity-score adjusted HR: 1.68, 95% CI: 1.19 to 2.38; p = 0.003). These results were sustained following propensity-score matched analysis. With regard to all-cause death and the composite endpoint of all-cause death and myocardial infarction, propensity-score adjusted analysis suggested a trend toward higher rates of these in the distal ULMCA PCI group, although this was not observed in the propensity-score matched analysis.
  
  
  CONCLUSIONS
  This study demonstrates that PCI for ostial/mid-shaft lesions is associated with better clinical outcomes than are distal bifurcation lesions in ULMCA, largely because there is a lower need for repeat revascularization in ostial/mid-shaft lesions.
authors.affiliation: Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.affiliation: Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: Interventional Cardiology Unit, A. O. Ordine Mauriziano Umberto I, Turin, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Meliga
authors.affiliation: Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.affiliation: Cardiovascular Institute, University of Ferrara, S. Anna Hospital, Ferrara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; Institute of Cardiology, University of Latvia, Riga, Latvia.
authors.forename: Sanda
authors.initials: S
authors.lastname: Jegere
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
authors.affiliation: Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
authors.affiliation: Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Charis
authors.initials: C
authors.lastname: Costopoulos
authors.affiliation: Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Center for Cardiovascular Research and Development of American Heart of Poland, Katowice, Poland.
authors.forename: Piotr P
authors.initials: PP
authors.lastname: Buszman
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy.
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.affiliation: Mount-Sinai Medical Center, New York, New York.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Christoph
authors.initials: C
authors.lastname: Naber
authors.affiliation: Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Ronan
authors.initials: R
authors.lastname: Margey
authors.affiliation: Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Arvind
authors.initials: A
authors.lastname: Agnihotri
authors.affiliation: Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
authors.affiliation: Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Piera
authors.initials: P
authors.lastname: Capranzano
authors.affiliation: Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.affiliation: Institut Hospitalier Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefevre
authors.affiliation: Institut Hospitalier Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.affiliation: Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; Institute of Cardiology, University of Latvia, Riga, Latvia.
authors.forename: Andrejs
authors.initials: A
authors.lastname: Erglis
authors.affiliation: Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy. Electronic address: colombo.antonio@hsr.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057216:Propensity Score; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: CI; DES; HR; IABP; LVEF; MACE; MI; PCI; TLR; TVR; ULMCA; confidence interval; distal bifurcation lesion; drug-eluting stent(s); hazard ratio; intra-aortic balloon pump; left ventricular ejection fraction; major adverse cardiac event(s); myocardial infarction; ostial/mid-shaft lesion; percutaneous coronary intervention; target lesion revascularization; target vessel revascularization; unprotected left main coronary artery