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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Incidence and Management of Restenosis After Treatment of Unprotected Left Main Disease With Drug-Eluting Stents

70 Restenotic Cases From a Cohort of 718 Patients: FAILS (Failure in Left Main Study)

Imad Sheiban, MD^_*, Dario Sillano, MD^_*, Giuseppe Biondi-Zoccai, MD^_*,_*, Alaide Chieffo, MD, Antonio Colombo, MD, Sabine Vecchio, MD, Massimo Margheri, MD, Julian P. Gunn, MD, Tushar Raina, MD, Francesco Liistro, MD^||, Leonardo Bolognese, MD^||, Michael S. Lee, MD^¶, Jonathan Tobis, MD^¶ and Claudio Moretti, MD, PhD^_*

^_* Division of Cardiology, University of Turin, Turin, Italy
St. Raffaele Hospital and Centro Cuore Columbus, Milan, Italy
Division of Cardiology, Ravenna Hospital, Ravenna, Italy
Division of Cardiology, University of Sheffield, Sheffield, United Kingdom
^|| Division of Cardiology, San Donato Hospital, Arezzo, Italy
^¶ Division of Cardiology, UCLA Medical Center, Los Angeles, California

Manuscript received February 2, 2009; revised manuscript received June 1, 2009, accepted June 1, 2009.

^_* Reprint requests and correspondence: Dr. Giuseppe Biondi-Zoccai, Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista Molinette Hospital, Corso Bramante 88-90, 10126 Turin, Italy (Email: gbiondizoccai{at}gmail.com).

Objectives: This study sought to retrospectively appraise the incidence and management of restenosis after drug-eluting stent (DES) implantation for unprotected left main (ULM) disease.

Background: The promising role of DES for ULM has been reported. However, no detailed data are available on subsequent restenosis.

Methods: From the total sample of patients with ULM treated with DES, we identified those presenting with angiographic ULM restenosis. The primary end point was the long-term rate of major adverse cardiac events (MACE), that is, death, myocardial infarction (MI), or target lesion revascularization (TLR). We also adjudicated stent thrombosis according to the Academic Research Consortium.

Results: Post-DES restenosis in ULM occurred in 70 of 718 patients (9.7%). Of these, 59 (84.3%) were treated percutaneously (34 [48.6%] with additional DES, 22 [31.4%] with standard or cutting balloons, 2 [2.9%] with rotational atherectomy, and 1 [1.4%] with a bare-metal stent), whereas 7 (10%) patients underwent bypass surgery and 4 (5.7%) were treated medically. In-hospital MACE included no periprocedural MI and only 1 (1.4%) death. After 27.2 ± 15.4 months, MACE occurred cumulatively in 18 (25.7%) patients, with death in 4 (5.7%), MI in 2 (2.9%), and TLR in 15 (21.4%). Patients treated with medical, interventional, and surgical therapy had the following MACE rates, respectively: 50%, 25.4%, and 14.3%. Definite, probable, and possible stent thrombosis occurred in 0 (0%), 1 (1.4%), and 1 (1.4%) patient, respectively.

Conclusions: DES restenosis in the ULM artery can be managed in most cases with a minimally invasive approach, achieving favorable early and late results.

Key Words: coronary artery disease • drug-eluting stent • left main coronary artery • percutaneous coronary intervention • restenosis

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CK = creatine kinase   DES = drug-eluting stent(s)   MACE = major adverse cardiovascular events   MI = myocardial infarction   PCI = percutaneous coronary intervention   ST = stent thrombosis   TLR = target lesion revascularization   ULM = unprotected left main disease

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J. Am. Coll. Cardiol. 2009 54: A27. [Full Text] [PDF]