Document Detail

Long-term outcomes after drug-eluting stent for the treatment of ostial left anterior descending coronary artery lesions.
MedLine Citation:
PMID:  21095288     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although drug-eluting stents (DES) have reduced restenosis in a broad range of lesions, there is limited data, from relatively small studies, on the safety and efficacy of DES for isolated ostial left anterior descending (LAD) stenoses. In addition, in the setting of these high-risk lesions, there is the issue of the potential involvement of the left main (LM) bifurcation, requiring subsequent revascularization for a lesion involving this critical location.
METHODS: Patients with a de novo isolated unprotected ostial LAD stenoses treated with DES were included. Evaluated end points were cardiac death, nonfatal myocardial infarction, overall target lesion revascularization (TLR), and the reintervention for a restenotic lesion located at the LM segment adjacent to the stent (TLR-LM).
RESULTS: A total of 162 patients were included: 95 underwent focal ostial LAD stenting and 67 stenting from the distal LM into the LAD ostium. The 2-year Kaplan-Meier estimates of cardiac death, nonfatal myocardial infarction, overall TLR, and TLR-LM were 2.6%, 2.1%, 8.3%, and 4.7%, respectively. Overall TLR and TLR-LM rates were higher in the focal ostial LAD stenting group. There was a trend toward an independent increased risk of TLR associated with focal ostial stenting. In addition, final minimal luminal diameter trended to be independently associated with TLR.
CONCLUSION: The present study showed that DES for isolated ostial LAD lesions is a feasible, safe, and effective treatment strategy. In addition, this study suggested the hypothesis that a default distal LM-LAD stenting, rather than focal ostial stenting, might provide more favorable outcomes. Nevertheless, larger specifically designed studies are needed.
Piera Capranzano; Alessandra Sanfilippo; Francesco Tagliareni; Davide Capodanno; Sergio Monaco; Gennaro Sardella; Arturo Giordano; Giuseppe M Sangiorgi; Corrado Tamburino
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  973-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Mosby, Inc. All rights reserved.
Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
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MeSH Terms
Cause of Death
Coronary Angiography
Coronary Restenosis / epidemiology,  etiology,  prevention & control
Coronary Stenosis / complications,  radiography,  surgery*
Drug-Eluting Stents*
Follow-Up Studies
Middle Aged
Myocardial Infarction / epidemiology*,  etiology,  prevention & control
Retrospective Studies
Time Factors

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