Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease: The Milan and New-Tokyo Registry.
There are only little data available on the comparison of clinical outcomes between a 1-stent strategy (1-SS) and a 2-stent strategy (2-SS) for percutaneous coronary intervention in unprotected distal left main disease.



Between April 2005 and August 2011, we recruited 937 consecutive unprotected distal left main patients treated with drug-eluting stents (1-SS, 608 patients; 2-SS, 329 patients). Major adverse cardiovascular events were defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR) during the median follow-up period of 1592 days. Furthermore, the individual components of major adverse cardiovascular events, cardiac death, and stent thrombosis were evaluated. More complex lesions were seen with 2-SS than with 1-SS. Cardiac death occurred more frequently with 1-SS than with 2-SS (propensity score-adjusted hazard ratio, 0.52; 95% confidence interval, 0.29-0.64; P=0.03), whereas TLR occurred more frequently with 2-SS than with 1-SS (propensity score-adjusted hazard ratio, 1.59; 95% confidence interval, 1.15-2.20; P=0.005). TLR was mainly driven by revascularizations after restenosis at the ostial left circumflex artery (propensity score-adjusted hazard ratio, 1.94; 95% confidence interval, 1.33-2.82; P=0.001). However, there were no differences in major adverse cardiovascular events, all-cause death, stent thrombosis, and myocardial infarction. Of the 139 pairs that were propensity score matched, only TLRs were significantly higher in the 2-SS group (hazard ratio, 1.59; 95% confidence interval, 1.00-2.53; P=0.05).



The difference between 1-SS and 2-SS in percutaneous coronary intervention for unprotected distal left main disease may be summarized by the high incidence of TLR, mainly because of restenosis at the ostial left circumflex artery in the 2-SS group.
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Kensuke
K
Takagi
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Toru
T
Naganuma
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Alaide
A
Chieffo
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Yusuke
Y
Fujino
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Azeem
A
Latib
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Satoko
S
Tahara
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Hisaaki
H
Ishiguro
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Matteo
M
Montorfano
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Mauro
M
Carlino
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Hiroyoshi
H
Kawamoto
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Naoyuki
N
Kurita
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Koji
K
Hozawa
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Shotaro
S
Nakamura
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo).
Sunao
S
Nakamura
From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo). info@emocolumbus.it.
Antonio
A
Colombo
D000368:Aged; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology; D003328:Coronary Thrombosis / Q000209:etiology; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007558:Italy; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; 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; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
drug-eluting stents; percutaneous coronary intervention; propensity score; stents; thrombosis