Five-year clinical follow-up of unprotected left main bifurcation lesion stenting: one-stent versus two-stent techniques versus double-kissing crush technique
| Autor: | Bing Xu, Jun-Jie Zhang, Xue-Song Qian, Ai-ping Zhang, Song Lin, Feng Li, Nai-Liang Tian, Shi-Qing Ding, Fei Ye, Shao-Liang Chen, Yao-Jun Zhang, Yue-Qiang Liu, Zhi-Zhong Liu |
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| Rok vydání: | 2012 |
| Předmět: |
Male
China medicine.medical_specialty Time Factors medicine.medical_treatment Myocardial Infarction Kaplan-Meier Estimate Coronary Angiography Prosthesis Design Balloon Severity of Illness Index Disease-Free Survival Risk Factors Angioplasty medicine Clinical endpoint Humans Prospective Studies cardiovascular diseases Myocardial infarction Angioplasty Balloon Coronary Prospective cohort study Aged Proportional Hazards Models Chi-Square Distribution business.industry Incidence Coronary Stenosis Stent Drug-Eluting Stents Middle Aged equipment and supplies medicine.disease Surgery Treatment Outcome surgical procedures operative Drug-eluting stent Multivariate Analysis Female Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | EuroIntervention. 8:803-814 |
| ISSN: | 1774-024X |
| DOI: | 10.4244/eijv8i7a123 |
| Popis: | The present study aimed to compare the long-term (five-year) safety and efficacy between the one-stent, two-stent and double-kissing (DK) crush strategies, utilising drug-eluting stents, for unprotected left main coronary artery (ULMCA) bifurcation lesions.Between March 2004 and April 2007, 633 consecutive patients with ULMCA bifurcation lesions (232 in the one-stent group and 401 in the two-stent group) were prospectively enrolled. The primary endpoint was the occurrence of major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction (MI), and target vessel revascularisation (TVR), at five-year follow-up. Patients in the the two-stent group were classified as DK crush (n=155) and other two-stent techniques (culotte, T-stenting, kissing stenting and classical crush, n=246). Forty-seven (16.8%) patients in the one-stent group crossed over to the two-stent group. The one-stent group was associated with an increased incidence of MI compared to the two-stent approach (10.5% vs. 5.5%, p=0.025). The crude rate of MACE at five years was 28.0% in the one-stent group and 28.4% in the two-stent group (p=0.927). DK crush was associated with a significantly decreased five-year MACE compared to the other two-stent approaches or the one-stent approach (DK crush: 14.8% vs. other two-stent approaches: 37.0%, one-stent approach: 28.0%, p0.001). The main benefit of DK crush primarily appeared to be secondary to a reduction in TVR (7.7% vs. 30.5% vs. 18.1%, p0.001). By Cox regression analyses, the non-DK crush two-stent technique, a high SYNTAX Score (≥33) or New Risk Stratification (NERS) score (20), and incomplete revascularisation were shown to be independent predictors of MACE at five-year follow-up.With distal left main true bifurcations, the two-stent technique (excluding DK crush) is an independent predictor of long-term MACE. DK crush is associated with more favourable long-term clinical outcomes. Confirmation of these findings is required from randomised controlled trials. |
| Databáze: | OpenAIRE |
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