Author + information
- Received March 26, 2013
- Revision received May 30, 2013
- Accepted June 6, 2013
- Published online February 1, 2014.
- Soledad Ojeda, MD, PhD∗∗ (, )
- Manuel Pan, MD, PhD∗,
- Pedro Martín, MD, PhD†,
- Francisco Mazuelos, MD, PhD∗,
- Javier Suárez de Lezo, MD, PhD∗,
- Miguel Romero, MD, PhD∗,
- José Segura, MD, PhD∗,
- Djordje Pavlovic, MD, PhD∗,
- Alfonso Medina, MD, PhD† and
- Jose Suárez de Lezo, MD, PhD∗
- ∗Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Córdoba, Spain
- †Department of Cardiology, Dr. Negrin Hospital, University of Las Palmas, Las Palmas de Gran Canaria, Spain
- ↵∗Reprint requests and correspondence:
Dr. Soledad Ojeda, Servicio de Cardiología, Hospital Reina Sofía, Avda Menéndez Pidal s/n, 14004 Córdoba, Spain.
Objectives The goal of this study was to assess the immediate and long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) in an unprotected distal left main coronary artery (UDLM).
Background PCI for UDLM-ISR can be complex. Limited information is available on procedural and clinical outcomes.
Methods Between May 2002 and February 2011, UDLM-ISR after drug-eluting stent implantation was observed in 79 of 1,102 patients (7%). Seventy-five were treated by repeat PCI using a simple approach (balloon/in-stent implantation) or a complex strategy (additional stent/double-stenting technique). A diagnosis of mild or severe restenosis was considered depending on the number of bifurcation segments affected (1 vs. >1). Major adverse cardiac events (MACE) were defined as cardiac death, target lesion revascularization, and myocardial infarction.
Results ISR treatment was performed using a simple approach in 44 (58%) patients, and using a complex strategy in 31 (42%). After 46 ± 26 months, the MACE rate was 22%. Patients treated with a simple approach had a lower incidence of MACE at follow-up compared with patients treated with a complex strategy, regardless of the restenosis extent (mild restenosis: 93% vs. 67%, p < 0.05; severe: 70% vs. 23%, p < 0.05). On Cox regression analysis, diabetes was the only predictor of MACE (hazard ratio [HR]: 4.94; 95% confidence interval [CI]: 1.03 to 23.70; p < 0.05), whereas a simple strategy for ISR treatment was associated with lower risk (HR: 0.25; 95% CI: 0.08 to 0.79; p = 0.02).
Conclusions PCI for UDLM-ISR is safe and feasible, with a high rate of procedural success and an acceptable long-term MACE rate. A simple strategy, when applicable, appears to be a good treatment option, associated with a lower event rate at follow-up.
Dr. Pan has been a consultant to Cordis/Johnson & Johnson. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 26, 2013.
- Revision received May 30, 2013.
- Accepted June 6, 2013.
- 2014 American College of Cardiology Foundation