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

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

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

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

<b><i>Aims:</i></b> 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. <b><i>Methods and Results:</i></b> 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], <i>p</i> &#x3c; 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], <i>p</i> &#x3c; 0.001, and HR 2.10 [1.41–3.14], <i>p</i> &#x3c; 0.001, respectively). <b><i>Conclusions:</i></b> HD was strongly associated with adverse cardiac events after PCI for ULMCA distal bifurcation lesions with DES.

The Impact of Diabetes Mellitus on Clinical Outcomes after Percutaneous Coronary Intervention with Drug-Eluting Stents for Left Main Distal Bifurcation Lesions in Patients with Chronic Kidney Disease

2020 ◽  
Vol 10 (6) ◽  
pp. 382-391
Author(s):  
Yusuke Watanabe ◽  
Satoru Mitomo ◽  
Toru Naganuma ◽  
Kensuke Takagi ◽  
Satoshi Matsuoka ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Clinical Outcomes ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Bifurcation Lesions ◽  
The Impact

<b><i>Background:</i></b> 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). <b><i>Objective:</i></b> We assessed the impact of DM on clinical outcomes after PCI for ULM distal bifurcation lesions in CKD patients compared to patients without DM. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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; <i>p</i> = 0.023). Cardiac mortality was comparable between both groups (adjusted HR 1.11; 95% CI 0.63–1.95; <i>p</i> = 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; <i>p</i> = 0.012). <b><i>Conclusion:</i></b> DM is strongly associated with adverse event after PCI for ULM distal bifurcation lesions in CKD patients compared to those without DM.

scholarly journals Long-term outcomes following drug-eluting stent implantation in unprotected left main bifurcation lesions

2007 ◽  
Vol 120 (7) ◽  
pp. 545-551 ◽  
Author(s):  
Lei GE ◽  
Cosgrave John ◽  
Iakovou Ioannis ◽  
Ju-ying QIAN ◽  
Agostoni Pierfrancesco ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Drug Eluting Stent ◽  
Left Main ◽  
Long Term Outcomes ◽  
Drug Eluting ◽  
Bifurcation Lesions

scholarly journals Impact of stent edge dissection detected by optical coherence tomography after current-generation drug-eluting stent implantation

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259693
Author(s):  
Hiroyuki Jinnouchi ◽  
Kenichi Sakakura ◽  
Tomonobu Yanase ◽  
Yusuke Ugata ◽  
Takunori Tsukui ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Clinical Outcomes ◽  
Cardiac Death ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Primary Study ◽  
Optical Coherence ◽  
Current Generation ◽  
Drug Eluting ◽  
Inverse Probability Weighted

Background Stent edge dissection (SED) is a well-known predictor of worse clinical outcomes. However, impact of SED after current-generation drug-eluting stent (DES) implantation remains unknown since there was no study using only current-generation DES to assess impact of SED. This study aimed to investigate a relationship between SED detected by optical coherence tomography (OCT) and clinical outcomes after current-generation DES implantation. Methods This study enrolled 175 patients receiving OCT after current-generation DES implantation. The SED group was compared with the non-SED group in terms of the primary study endpoints which was the cumulative incidence of major adverse cardiac event (MACE) composed of cardiac death, target vessel myocardial infarction (TV-MI), and clinically-driven target lesion revascularization (CD-TLR). Results Of 175 patients, SED detected by OCT was observed in 32 patients, while 143 patients did not show SED. In the crude population, the SED group showed a significantly higher incidence of CD-TLR, definite stent thrombosis, TV-MI and cardiac death relative to the non-SED group. After adjustment by an inverse probability weighted methods, the SED group showed a significantly higher incidence of MACE compared with the non-SED group (hazard ratio 3.43, 95% confidence interval 1.09–10.81, p = 0.035). Fibrocalcific or lipidic plaques, greater lumen eccentricity, and stent-oversizing were the predictors of SED. Conclusions SED detected by OCT after the current-generation DES implantation led to unfavorable outcomes. Aggressive post-dilatation around the stent edge might worse clinical outcomes due to SED, although achievement of optimal stent expansion is strongly encouraged to improve clinical outcomes.

P971Impact of treatment strategy on 1-year outcome for Left Main trifurcation lesions

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Tani ◽  
S Mitomo ◽  
K Tanaka ◽  
S Tahara ◽  
S Nakamura
Keyword(s):  
Clinical Outcomes ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Restenosis Rate ◽  
Left Main ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Significant Difference ◽  
Drug Eluting

Abstract Background/Introduction Limited data exist regarding procedural strategy and clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main (LM) trifurcation lesion. Purpose The aim of this study is to evaluate 1-year clinical outcomes after LM trifurcation PCI comparing different strategies in kissing balloon inflation (KBI). Methods From 1, January, 2011 to 31, March, 2017, patients who underwent LM trifurcation PCI with second generation drug-eluting stent in our center were retrospectively analyzed. They were categorized into single-stent KBT group (KBT in left anterior descending artery [LAD] and left circumflex artery [LCX], or LAD and high lateral branch [HL]) and no-KBT group. Primary endpoint is restenosis in the lesions. Results Among 1301 patients who underwent LM PCI during the study period, 163 patients (12.5%) had a trifurcation lesion. Regarding the number of stents used for the lesions, 1, 2 and 3 stents were used in 75.4%, 22.0% and 2.5%, respectively. Median follow-up period of LM trifurcation patients was 265 days (interquartile range: 81–564). In the no-KBT group (64 patients), 19 patients experienced restenosis of HL and LCX (HL: 8 patients, LCX: 0 patient, and both: 11 patients). In the KBT-group, KBT for LAD and LCX was performed in 47 patients, and of them, 19 patients experienced restenosis of LM-LAD, HL and LCX (HL: 12 patients, LCX: 6 patients and all: 1 patient). On the other hand, in 9 patients with KBT for LAD and HL, there were no restenosis cases at 1-year follow-up. There was no statistically significant difference in restenosis rate between the no-KBI and KBT group (29.6% vs. 40.4%, p=0.69). Restenosis rates in each segments Conclusion After LM trifurcation PCI, restenosis rate at 1-year follow-up was high, and no difference between no-KBT and KBT group overall. However, there was no restenosis case in patients with KBT for LAD and HL.

Clinical outcomes after zotarolimus and everolimus drug eluting stent implantation in coronary artery bifurcation lesions: insights from the RESOLUTE All Comers Trial

Heart ◽  
2013 ◽  
Vol 99 (17) ◽  
pp. 1267-1274 ◽  
Author(s):  
Roberto Diletti ◽  
Hector M Garcia-Garcia ◽  
Christos V Bourantas ◽  
Robert Jan van Geuns ◽  
Nicolas M Van Mieghem ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Clinical Outcomes ◽  
Stent Implantation ◽  
Drug Eluting Stent ◽  
Drug Eluting ◽  
Bifurcation Lesions
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