| Institution: | 1. Deutsches Herzzentrum München, Department of Cardiology, Technische Universität, Munich, Germany;2. DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany;3. 1. Med. Klinik, Klinikum Rechts der Isar, Technische Universität, Munich, Germany;4. Mater Private Hospital, Department of Cardiology, Dublin, Ireland;5. Royal College of Surgeons, Dublin, Ireland;6. Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland;7. Heart Centre Segeberger Kliniken, Bad Segeberg, Germany;8. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany |
| Abstract: | ObjectivesThe 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.BackgroundAlthough drug-eluting stents are safe and effective for treatment of the ULMCA, increased rates of repeat revascularization have been observed.MethodsThis 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.ResultsA 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.ConclusionsMortality 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. |
