Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease: The Milan and New-Tokyo Registry

Kensuke Takagi, Toru Naganuma, Alaide Chieffo, Yusuke Fujino, Azeem Latib, Satoko Tahara, Hisaaki Ishiguro, Matteo Montorfano, Mauro Carlino, Hiroyoshi Kawamoto, Naoyuki Kurita, Koji Hozawa, Shotaro Nakamura, Sunao Nakamura, Antonio Colombo
Circulation. Cardiovascular Interventions 2016, 9 (11)

BACKGROUND: 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.

METHODS AND RESULTS: 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).

CONCLUSIONS: 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.

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