Immediate results and long-term clinical outcome of patients with unprotected distal left main restenosis: the CORPAL registry (Córdoba and Las Palmas).
OBJECTIVE
The goal of this study was to assess the immediate and long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) in an unprotected distal left main coronary artery (UDLM).


BACKGROUND
PCI for UDLM-ISR can be complex. Limited information is available on procedural and clinical outcomes.


METHODS
Between May 2002 and February 2011, UDLM-ISR after drug-eluting stent implantation was observed in 79 of 1,102 patients (7%). Seventy-five were treated by repeat PCI using a simple approach (balloon/in-stent implantation) or a complex strategy (additional stent/double-stenting technique). A diagnosis of mild or severe restenosis was considered depending on the number of bifurcation segments affected (1 vs. >1). Major adverse cardiac events (MACE) were defined as cardiac death, target lesion revascularization, and myocardial infarction.


RESULTS
ISR treatment was performed using a simple approach in 44 (58%) patients, and using a complex strategy in 31 (42%). After 46 ± 26 months, the MACE rate was 22%. Patients treated with a simple approach had a lower incidence of MACE at follow-up compared with patients treated with a complex strategy, regardless of the restenosis extent (mild restenosis: 93% vs. 67%, p < 0.05; severe: 70% vs. 23%, p < 0.05). On Cox regression analysis, diabetes was the only predictor of MACE (hazard ratio [HR]: 4.94; 95% confidence interval [CI]: 1.03 to 23.70; p < 0.05), whereas a simple strategy for ISR treatment was associated with lower risk (HR: 0.25; 95% CI: 0.08 to 0.79; p = 0.02).


CONCLUSIONS
PCI for UDLM-ISR is safe and feasible, with a high rate of procedural success and an acceptable long-term MACE rate. A simple strategy, when applicable, appears to be a good treatment option, associated with a lower event rate at follow-up.
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Córdoba, Spain. Electronic address: soledad.ojeda18@gmail.com.
Soledad
S
Ojeda
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Córdoba, Spain.
Manuel
M
Pan
Department of Cardiology, Dr. Negrin Hospital, University of Las Palmas, Las Palmas de Gran Canaria, Spain.
Pedro
P
Martín
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Córdoba, Spain.
Francisco
F
Mazuelos
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Córdoba, Spain.
Javier
J
Suárez de Lezo
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Córdoba, Spain.
Miguel
M
Romero
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Córdoba, Spain.
José
J
Segura
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Córdoba, Spain.
Djordje
D
Pavlovic
Department of Cardiology, Dr. Negrin Hospital, University of Las Palmas, Las Palmas de Gran Canaria, Spain.
Alfonso
A
Medina
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Córdoba, Spain.
Jose
J
Suárez de Lezo
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
bifurcation lesion; drug-eluting stent(s); left main; restenosis