title: Impact of a combination of full coverage stenting and proximal optimization technique on long term outcome for unprotected distal left main disease.
abstract: BACKGROUND
  There is no consensual opinion regarding the percutaneous coronary intervention (PCI) procedure for unprotected distal left main (UDLM) lesion.
  
  
  METHODS
  Between April 2005 and August 2011, 586 consecutive patients with UDLM stenosis treated with drug-eluting stents were recruited for this study to clarify the impact of combination of full-coverage stenting and proximal optimization technique (POT) for UDLM lesion. An optimal strategy of full-coverage stenting and POT was performed in 353 patients and the other 233 patients were not optimally treated. Major adverse cardiovascular events (MACEs) were defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR) during follow-up period. TLRs were also evaluated for main branch (MB) restenosis.
  
  
  RESULTS
  At 1615days of follow-up, MACE occurred in 166 (28.3%) patients. The occurrence of MACE and TLR had a trend to being lower in the optimal strategy [propensity score-adjusted HR, 0.73 (95% CI, 0.53-1.01), p=0.05 and propensity score-adjusted HR, 0.69 (95% CI, 0.46-1.02), p=0.06, respectively]. TLR of the MB occurred significantly less frequently in the optimal strategy [propensity score-adjusted HR, 0.34 (95% CI, 0.15-0.76), p=0.008]. Cardiac death occurred in 28 (4.8%) patients. There was no significant difference in cardiac death between the two groups. These results were sustained after propensity-score matching.
  
  
  CONCLUSIONS
  An optimal PCI strategy of full-coverage stenting and POT might be effective for UDLM lesion to reduce the occurrence of MACE, especially driven by TLR of the MB.
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujino
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Yabushita
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Mitomo
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Kawamoto
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Tahara
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Warisawa
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Karube
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Ishiguro
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kurita
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hozawa
authors.affiliation: Department of Cardiology, New Tokyo Hospital; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan. Electronic address: boss0606@pluto.plala.or.jp.
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D023903:Coronary Restenosis / Q000209:etiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Distal left main disease; Drug-eluting stent; Full coverage; Proximal optimization technique