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European Heart Journal Advance Access published online on June 9, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp223
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Ostial and midshaft lesions vs. bifurcation lesions in 1111 patients with unprotected left main coronary artery stenosis treated with drug-eluting stents: results of the survey from the Italian Society of Invasive Cardiology

Tullio Palmerini1,*, Diego Sangiorgi1, Antonio Marzocchi1, Corrado Tamburino2, Imad Sheiban3, Massimo Margheri4, Giuseppe Vecchi5, Giuseppe Sangiorgi6, Michele Ruffini7, Antonio L. Bartorelli8, Carlo Briguori9, Luigi Vignali10, Francesco Di Pede11, Angelo Ramondo12, Luigi Inglese13, Marco De Carlo14, Leonardo Bolognese15, Alberto Benassi16, Cataldo Palmieri17, Vincenzo Filippone18, Fabio Barlocco19, Giulia Lauria1 and Stefano De Servi19

1 Istituto di Cardiologia, Policlinico S. Orsola, Università di Bologna, Policlinico S. Orsola, Via Massarenti 9, 40 138 Bologna, Italy
2 Dipartimento di Cardiologia, Ospedale Ferrarotto, Università di Catania, Catania, Italy
3 Divisione di Cardiologia, Università di Torino, Torino, Italy
4 Dipartimento Cardiovascolare, Ospedale Careggi, Università di Firenze, Firenze, Italy
5 Dipartimento di Cardiologia, Ospedale S. Maria delle Croci, Ravenna, Italy
6 Centro Emocolumbus, Milano, Italy
7 Dipartimento di Cardiologia, Ospedale degli Infermi, Rimini, Italy
8 Centro Cardiologico Monzino, Università di Milano, Milano, Italy
9 Dipartimento di Cardiologia, Clinica Mediterranea, Napoli, Italy
10 Unità Operativa di Cardiologia, Azienda Ospedaliero-Universitaria, Parma, Italy
11 Dipartimento di Cardiologia, Azienda Ospedaliera, Mestre, Italy
12 Dipartimento di Scienze Cardiovascolari, Università di Padova, Padova, Italy
13 Cardiovascular Interventional Radiology Department, IRCCS Policlinico S. Donato, S, Donato Milanese, Italy
14 Dipartimento Cardio-Toracico, Ospedale Cisanello, Pisa, Italy
15 Dipartimento Cardiovascolare, Ospedale S. Donato, Arezzo, Italy
16 Dipartimento di Cardiologia, Hesperia Hospital, Modena, Italy
17 Istituto Fisiologia Clinica, CNR, Massa, Italy
18 Dipartimento Cardiovascolare, Ospedale Cervello, Palermo, Italy
19 Dipartimento di Malattie Cardiovascolari, Ospedale Civile, Legnano, Italy

Received 4 November 2008; revised 10 April 2009; accepted 6 May 2009 * Corresponding author. Tel: +39 051 349858, Fax: +39 051 344859, Email: tulliopalmerini{at}hotmail.com

Aims: In this study, we compared the cumulative risk of major adverse cardiac events (MACE) of patients with distal unprotected left main coronary artery (ULMCA) stenosis with those of patients with ostial and midshaft lesions treated with drug-eluting stent (DES).

Methods and results: The survey promoted by the Italian Society of Invasive Cardiology on ULMCA stenosis was an observational study involving 19 high-volume Italian centres. We enrolled 1111 patients with ULMCA stenosis treated with DES. Major adverse cardiac events were defined as death, myocardial infarction, and target lesion revascularization. Three hundred and thirty-four patients had ostial or midshaft lesions (group 1) and 777 bifurcations (group 2). The adjusted hazards ratio of the risk of 2 year MACE of patients in group 2 vs. patients in group 1 was 1.50 (P = 0.024). However, we observed that there was a significant difference between patients with bifurcations treated with two stents and those in group 1 (P = 0.001), but not between patients with bifurcations treated with one stent and those in group 1 (P = 0.38).

Conclusion: Patients with bifurcations have a worse outcome than patients with ostial and midshaft lesions. However, the technique used to treat bifurcations has a significant impact on clinical outcomes.

Key Words: Stents • Bifurcations • Left main


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