Author + information
- Received April 6, 2020
- Revision received June 18, 2020
- Accepted July 14, 2020
- Published online October 5, 2020.
- Jens Wiebe, MDa,b,∗ (, )
- Constantin Kuna, MDa,
- Tareq Ibrahim, MDc,
- Martin Lösla,
- Salvatore Cassese, MD, PhDa,
- Sebastian Kufner, MDa,
- Heribert Schunkert, MDa,b,
- Robert A. Byrne, MB, PhDd,e,
- Karl-Ludwig Laugwitz, MDb,c,
- Marco Valgimigli, MDf,
- Gert Richardt, MDg,
- Julinda Mehilli, MDb,h and
- Adnan Kastrati, MDa,b
- aDeutsches Herzzentrum München, Department of Cardiology, Technische Universität, Munich, Germany
- bDZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- c1. Med. Klinik, Klinikum Rechts der Isar, Technische Universität, Munich, Germany
- dMater Private Hospital, Department of Cardiology, Dublin, Ireland
- eRoyal College of Surgeons, Dublin, Ireland
- fDepartment of Cardiology, Inselspital, University of Bern, Bern, Switzerland
- gHeart Centre Segeberger Kliniken, Bad Segeberg, Germany
- hMedizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- ↵∗Address for correspondence:
Dr. med. Jens Wiebe, Deutsches Herzzentrum München, Technische Universität, Lazarettstrasse 36, 80636 Munich, Germany.
Objectives The aim of this study was to evaluate the prognostic impact of target lesion revascularization (TLR) of the unprotected left main coronary artery (ULMCA) after stent failure.
Background Although drug-eluting stents are safe and effective for treatment of the ULMCA, increased rates of repeat revascularization have been observed.
Methods This is a patient-level pooled analysis of the randomized ISAR-LEFT-MAIN (Drug-Eluting-Stents for Unprotected Left Main Stem Disease) and ISAR-LEFT-MAIN-2 (Drug-Eluting Stents to Treat Unprotected Coronary Left Main Disease) trials, in which patients underwent stenting of the ULMCA. The present analysis includes patients who underwent angiography during follow-up. Patients with TLR were compared with those without. Additional long-term clinical follow-up after TLR was conducted, and its influence on mortality was evaluated. Mortality was calculated using the Kaplan-Meier method. Predictors of mortality were assessed in a multivariate analysis.
Results A total of 1,001 patients were eligible, of whom 166 experienced TLR. The 5-year mortality rate was 30.2% in patients with TLR compared with 17.3% in those without TLR (p < 0.001). In the multivariate analysis, glomerular filtration rate (−30 ml/min; hazard ratio [HR]: 2.25; 95% confidence interval [CI]: 1.54 to 3.27; p < 0.001), chronic obstructive pulmonary disease (HR: 4.95; 95% CI: 1.33 to 18.42; p = 0.02), and body mass index (+5 kg/m2; HR: 1.61; 95% CI: 1.12 to 2.32; p = 0.01) were independent predictors of mortality after TLR due to left main stent failure. The type of repeat revascularization and the underlying stent did not influence the mortality after TLR of the ULMCA.
Conclusions Mortality after TLR for left main stent failure is high. Patient-related factors seem to have a greater impact on mortality after TLR than other variables.
- coronary artery disease
- in-stent restenosis
- repeat revascularization
- stent failure
- unprotected left main stenosis
Dr. Mehilli has received an institutional research grant from Boston Scientific; and has received lecture fees from AstraZeneca, Bristol Myers Squibb, Boston Scientific, Edwards Lifesciences, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received April 6, 2020.
- Revision received June 18, 2020.
- Accepted July 14, 2020.
- 2020 American College of Cardiology Foundation
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