title: Long-Term Outcomes After Stent Implantation for Left Main Coronary Artery (from the Multicenter Assessing Optimal Percutaneous Coronary Intervention for Left Main Coronary Artery Stenting Registry).
abstract: We assessed long-term outcomes after left main coronary artery (LMCA) stenting based on lesion types and stenting strategies. In the Assessing Optimal percutaneous coronary Intervention for Left Main Coronary Artery stenting registry, we evaluated 1,607 consecutive patients undergoing stent implantation for unprotected LMCA lesions (bifurcation lesions: n = 1318 and nonbifurcation lesions: n = 289). Among the bifurcation lesions, 1,281 lesions were treated with stenting across the bifurcation (bifurcation 1-stent strategy: n = 999 or bifurcation 2-stent strategy: n = 282). Among the nonbifurcation lesions, 219 lesions were treated with nonbifurcation stenting. The median follow-up duration was 4.6 (95% CI 4.5 to 4.8) years. The 5-year risk of bifurcation lesions relative to nonbifurcation lesions was neutral for target lesion revascularization (TLR) (adjusted hazard ratio [HR] 0.82, 95% CI 0.55 to 1.23, p = 0.34) and all-cause death (adjusted HR 1.22, 95% CI 0.87 to 1.71, p = 0.26). The risk of the bifurcation 1-stent strategy relative to nonbifurcation stenting in nonbifurcation lesions was also neutral for TLR (adjusted HR 1.19, 95% CI 0.74 to 1.90, p = 0.47) and all-cause death (adjusted HR 0.81, 95% CI 0.56 to 1.18, p = 0.27). However, the bifurcation 2-stent strategy was associated with worse clinical outcomes than the bifurcation 1-stent strategy in TLR (adjusted HR 1.76, 95% CI 1.23 to 2.52, p = 0.002) and definite or probable stent thrombosis (crude HR 3.50, 95% CI 1.32 to 9.33, p = 0.01), despite neutral risk for all-cause death (adjusted HR 1.00, 95% CI 0.74 to 1.36, p = 0.99). There was no definite or probable very late stent thrombosis up to 5 years. In conclusion, long-term outcomes after stent implantation for unprotected LMCA lesions were not dependent on the bifurcation lesion types but related to the bifurcation stenting strategies with worse outcomes for the bifurcation 2-stent strategy.
authors.affiliation: Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Ohya
authors.affiliation: Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.affiliation: Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Toyofuku
authors.affiliation: Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hirooki
authors.initials: H
authors.lastname: Higami
authors.affiliation: Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fuku
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
authors.forename: Kyohei
authors.initials: K
authors.lastname: Yamaji
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Muranishi
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Yamaji
authors.affiliation: Department of Cardiology, Chikamori Hospital, Kochi, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Nishida
authors.affiliation: Department of Cardiology, Chikamori Hospital, Kochi, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Furukawa
authors.affiliation: Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Tada
authors.affiliation: Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.
authors.forename: Euihong
authors.initials: E
authors.lastname: Ko
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.affiliation: Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakamoto
authors.affiliation: Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Department of Cardiology, Chikamori Hospital, Kochi, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kawai
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: taketaka@kuhp.kyoto-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D023921:Coronary Stenosis / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D013927:Thrombosis / Q000453:epidemiology; D016896:Treatment Outcome