TCT-692 Impact of Treatment Strategy on Clinical Outcomes Differs Between Patients with Left Main and those with Non-Left Main Bifurcation Lesions

Background: The impact of diabetes mellitus (DM) on clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main (ULM) distal bifurcation lesions in patients with chronic kidney disease (CKD) is poorly understood in the era of drug-eluting stents (DESs). Objective: We assessed the impact of DM on clinical outcomes after PCI for ULM distal bifurcation lesions in CKD patients compared to patients without DM. Methods: We identified 1,832 consecutive patients who underwent PCI for ULM lesions at New Tokyo Hospital, Matsudo, Japan, San Raffaele Scientific Institute, Milan, Italy, and EMO-GVM, Centro Cuore Columbus, Milan, Italy between January 2005 and August 2015. Of the 1,832 patients, 1,391 were treated with DESs. We excluded 750 patients without CKD and 89 hemodialysis patients. Finally, 552 patients with CKD were included: 219 with DM (DM group) and 333 without DM (no DM group). The primary endpoint was target lesion failure (TLF) at 5 years. TLF was defined as a composite of cardiac death, target lesion revascularization (TLR), and myocardial infarction. Results: Patients in the DM group were more likely to have hypertension, dyslipidemia, peripheral artery disease, and lower ejection fraction and were more frequently using insulin for DM. The TLF rate during the follow-up period was significantly higher in the DM than in the no DM group (adjusted hazard ratio [HR] 1.50; 95% confidence interval [CI] 1.06–2.13; p = 0.023). Cardiac mortality was comparable between both groups (adjusted HR 1.11; 95% CI 0.63–1.95; p = 0.71). The TLR rate was significantly higher in the DM group than in the no DM group (adjusted HR 1.69; 95% CI 1.12–2.54; p = 0.012). Conclusion: DM is strongly associated with adverse event after PCI for ULM distal bifurcation lesions in CKD patients compared to those without DM.

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Clinical outcomes of double stent strategy for unprotected left main distal bifurcation lesions using current generation drug eluting stent comparing to early generation drug eluting stent; The Milan and New Tokyo ( MITO ) registry

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.28962 ◽

2020 ◽

Author(s):

Yusuke Watanabe ◽

Satoru Mitomo ◽

Toru Naganuma ◽

Hiroyoshi Kawamoto ◽

Kensuke Takagi ◽

...

Keyword(s):

Clinical Outcomes ◽

Drug Eluting Stent ◽

Left Main ◽

Early Generation ◽

Current Generation ◽

Drug Eluting ◽

Bifurcation Lesions ◽

Double Stent

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Final kissing balloon inflation by classic crush stenting did not improve the clinical outcomes for the treatment of unprotected left main bifurcation lesions: The importance of double-kissing crush technique

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.21317 ◽

2008 ◽

Vol 71 (2) ◽

pp. 166-172 ◽

Cited By ~ 20

Author(s):

Shaoliang Chen ◽

Junjie Zhang ◽

Fei Ye ◽

Yundai Chen ◽

Weiyi Fang ◽

...

Keyword(s):

Clinical Outcomes ◽

Left Main ◽

Balloon Inflation ◽

Bifurcation Lesions ◽

Crush Technique

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Clinical Outcomes of Dialysis Patients Treated with Drug-Eluting Stent for Left Main Distal Bifurcation Lesions

Cardiorenal Medicine ◽

10.1159/000510731 ◽

2021 ◽

Vol 11 (2) ◽

pp. 99-108

Author(s):

Yusuke Watanabe ◽

Satoru Mitomo ◽

Ozan M. Demir ◽

Kuan-Liang Liu ◽

Ying-Chang Tung ◽

...

Keyword(s):

Clinical Outcomes ◽

High Volume ◽

Coronary Intervention ◽

Target Lesion ◽

Drug Eluting Stent ◽

Left Main ◽

Cardiac Events ◽

Drug Eluting ◽

Bifurcation Lesions ◽

Target Lesion Failure

Aims: We assessed clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) distal bifurcation lesions using drug-eluting stents (DES) in hemodialysis (HD) patients compared to non-HD patients. Methods and Results: We identified 1,858 consecutive patients who underwent PCI for ULMCA distal bifurcation lesions at 4 high-volume centers in Japan, Italy, and Taiwan between January 2005 and December 2015. Of them, 1,416 patients were treated with DES including 113 HD patients and 1,303 non-HD patients. The primary end point was target lesion failure (TLF) defined as a composite of cardiac death, target lesion revascularization (TLR), and myocardial infarction. HD patients were more likely to be younger and have diabetes mellitus, dyslipidemia, peripheral artery disease, lower ejection fraction, and higher EuroSCORE. TLF rate at 3 years was significantly higher in HD group than in non-HD group (adjusted hazard ratio [HR] 2.43 [1.75–3.38], p < 0.001). Cardiac mortality and TLR rate were also significantly higher in HD group than in non-HD group (adjusted HR 3.85 [2.34–6.34], p < 0.001, and HR 2.10 [1.41–3.14], p < 0.001, respectively). Conclusions: HD was strongly associated with adverse cardiac events after PCI for ULMCA distal bifurcation lesions with DES.

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