First generation versus new generation drug-eluting stents for the treatment of ostial/midshaft lesions in unprotected left main coronary artery: The Milan and New-Tokyo (MITO) registry

Toru Naganuma, Alaide Chieffo, Kensuke Takagi, Vasileios F. Panoulas, Satoru Mitomo, Alessandro Sticchi, Azeem Latib, Tadashi Miyazaki, Katsumasa Sato, Charis Costopoulos, Yusuke Fujino, Matteo Montorfano, Mauro Carlino, Sunao Nakamura, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objectives: To compare the clinical outcomes following unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) of ostial/midshaft lesions between first and new generation drug-eluting stents (DES). Background: Clinical outcomes after treatment of ostial/midshaft lesions in ULMCA with first generation DES were favorable. However, to date, data regarding treatment for those lesion subsets with new generation DES have not been reported. Methods: A total of 219 patients with ostial/midshaft lesions in ULMCA treated with first (n = 139) or new generation DES (n = 80) were analyzed. Results: There was a higher prevalence of IVUS use (35.2% vs. 50.0%, P = 0.032) and postdilation (70.5% vs. 93.8%, P < 0.001) with larger maximum balloon diameter (3.81 ± 0.45 vs. 4.08 ± 0.44, P < 0.001) in the new generation DES group. At a median follow-up period of 730 days, there were no significant differences in the propensity-score adjusted analyses, for major adverse cardiac events (MACE) defined as composite endpoint of all-cause death, myocardial infarction, and target vessel revascularization (hazard ratio (HR) [new vs. first generation DES]: 1.22; 95% confidence interval (CI): 0.64-2.31; P = 0.549). Of note, target lesion revascularization rates at 2-years were only 0.9% and 2.7%, for first and new generation DES groups, respectively (P = 0.339). On multivariable analysis, SYNTAX score (HR: 1.06; 95% CI: 1.02-1.11, P = 0.006) and European System for Cardiac Operative Risk Evaluation (HR: 1.14; 95% CI: 1.00-1.31, P = 0.051) were independent predictors for MACE. Conclusions: This study suggests that new generation DES for ostial/midshaft lesions in ULMCA are associated with favorable clinical outcomes, similar to those observed with first generation DES.

Original languageEnglish (US)
Pages (from-to)E63-E69
JournalCatheterization and Cardiovascular Interventions
Volume85
Issue number3
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

Keywords

  • New generation drug-eluting stents
  • Ostial/midshaft lesion
  • Percutaneous coronary intervention
  • Unprotected left main coronary artery

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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