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Early and long-term results of percutaneous coronary intervention for unprotected left main trifurcation disease.
- Source :
-
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2009 Jan 01; Vol. 73 (1), pp. 25-31. - Publication Year :
- 2009
-
Abstract
- Objectives: We aimed to conduct a retrospective cohort study focusing on our 5-year experience in the percutaneous treatment of unprotected left main (ULM) trifurcation disease.<br />Background: Percutaneous treatment of ULM trifurcation remains a challenging and rare procedure for most interventional cardiologists. Moreover, data on long-term outcomes are lacking.<br />Methods: We retrieved all patients with ULM trifurcation disease treated percutaneously at our Institution since 2002, and adjudicated baseline, procedural, and outcome data. The primary end point was the long-term rate of major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, bypass surgery, or target vessel revascularization).<br />Results: A total of 27 patients underwent percutaneous coronary intervention with stent implantation for ULM trifurcation disease, with 14 (52%) cases of true trifurcations, i.e., with concomitant significant stenoses of the distal ULM/ostial left anterior descending plus ostial ramus intermedius and ostial circumflex. Bare-metal stents were implanted in 8 (29%) patients and drug-eluting stents (DES) in 26 (96%), with a main branch stent only strategy in 11 (40%), T stenting in 9 (33%), and V stenting in 6 (27%). Procedural and clinical success occurred in 26 (96%), with one postprocedural death. Angiographic follow-up was obtained in 22 patients (81%), and clinical follow-up was completed in all subjects after a median of 28 +/- 17 months, showing overall MACE in 9 (33%), with cardiac death in 4 (15%), myocardial infarction in 1 (4%), coronary artery bypass grafting (CABG) in 4 (15%), and percutaneous target vessel revascularization in 5 (19%). Definite stent thrombosis was adjudicated in 1 (3%) patient. Treatment of a true trifurcation lesion and recurrence of angina during follow-up were significantly associated with an increased risk of MACE (P = 0.029 and P = 0.050, respectively).<br />Conclusions: Percutaneous treatment of ULM trifurcation disease is feasible, associated with favorable mid-term results, and may be considered given its low invasiveness in patients at high surgical risk or with multiple comorbidities.<br /> ((c) 2008 Wiley-Liss, Inc.)
- Subjects :
- Aged
Aged, 80 and over
Cardiovascular Diseases etiology
Cardiovascular Diseases mortality
Coronary Angiography
Coronary Stenosis diagnostic imaging
Feasibility Studies
Female
Humans
Male
Middle Aged
Prosthesis Design
Retrospective Studies
Risk Assessment
Severity of Illness Index
Time Factors
Treatment Outcome
Angioplasty, Balloon, Coronary adverse effects
Angioplasty, Balloon, Coronary instrumentation
Angioplasty, Balloon, Coronary mortality
Cardiovascular Diseases prevention & control
Coronary Stenosis therapy
Drug-Eluting Stents
Metals
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1522-726X
- Volume :
- 73
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
- Publication Type :
- Academic Journal
- Accession number :
- 19089932
- Full Text :
- https://doi.org/10.1002/ccd.21759