Long-term clinical outcomes after percutaneous coronary intervention for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery: the DELTA Registry (drug-eluting stent for left main coronary artery disease): a multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment

JACC Cardiovasc Interv. 2013 Dec;6(12):1242-9. doi: 10.1016/j.jcin.2013.08.005.

Abstract

Objectives: The aim of this study was to compare, in a large all-comer registry, the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery (ULMCA) stenosis.

Background: Limited data are available regarding clinical outcomes following DES implantation at the different ULMCA sites.

Methods: Patients with ULMCA stenosis treated by PCI with DES were analyzed in this multinational registry.

Results: A total of 1,612 patients were included: 482 were treated for ostial/mid-shaft lesions versus 1,130 for distal bifurcation lesions. At a median follow-up period of 1,250 (interquartile range: 987 to 1,564) days, PCI for distal bifurcation lesions was associated with a higher incidence of major adverse cardiac events (propensity-score adjusted hazard ratio [HR]: 1.48, 95% confidence interval [CI]: 1.16 to 1.89; p = 0.001), largely because of the higher target vessel revascularization rate observed in this group as compared to the ostial/mid-shaft lesions group (propensity-score adjusted HR: 1.68, 95% CI: 1.19 to 2.38; p = 0.003). These results were sustained following propensity-score matched analysis. With regard to all-cause death and the composite endpoint of all-cause death and myocardial infarction, propensity-score adjusted analysis suggested a trend toward higher rates of these in the distal ULMCA PCI group, although this was not observed in the propensity-score matched analysis.

Conclusions: This study demonstrates that PCI for ostial/mid-shaft lesions is associated with better clinical outcomes than are distal bifurcation lesions in ULMCA, largely because there is a lower need for repeat revascularization in ostial/mid-shaft lesions.

Keywords: CI; DES; HR; IABP; LVEF; MACE; MI; PCI; TLR; TVR; ULMCA; confidence interval; distal bifurcation lesion; drug-eluting stent(s); hazard ratio; intra-aortic balloon pump; left ventricular ejection fraction; major adverse cardiac event(s); myocardial infarction; ostial/mid-shaft lesion; percutaneous coronary intervention; target lesion revascularization; target vessel revascularization; unprotected left main coronary artery.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Coronary Artery Bypass* / adverse effects
  • Coronary Artery Bypass* / mortality
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / surgery
  • Coronary Artery Disease / therapy*
  • Coronary Stenosis / diagnosis
  • Coronary Stenosis / mortality
  • Coronary Stenosis / surgery
  • Coronary Stenosis / therapy*
  • Drug-Eluting Stents
  • Europe / epidemiology
  • Female
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / mortality
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / instrumentation
  • Percutaneous Coronary Intervention* / mortality
  • Propensity Score
  • Registries
  • Republic of Korea / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology