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Research Article Open access CC BY 3.0

A Meta-analysis of Ostial and Trunk versus Distal Lesions in Unprotected Left Main Coronary Artery Stenting

Wassef Karrowni, Amandeep S. Dhaliwal, Nader Makki, Ankur Vyas, Amy Blevins, Saadeddine Dughman, Saket Girotra, Peter Cram, Phillip A. Horwitz

Cardiology and Angiology: An International Journal · pp. 260–277 · Published 7 Jul 2014

10.9734/CA/2014/11172

Abstract

Aims: To assess outcomes for percutaneous coronary intervention (PCI) in ostial and trunk versus distal unprotected left main coronary artery (LMCA) lesions in the drug-eluted stent (DES) era. Study Design: A meta-analysis and systematic review. Methods: With the help of a librarian, we searched Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and the Clinical Trials Registry from 2001 to July 2012. We included studies that enrolled ≥ 50 patients and had ≥6 months of follow-up. Our co-primary endpoints were the incidence of major adverse cardiac events (MACE) and target lesion/vessel revascularization (TLR/TVR). Data was abstracted and analyzed by two independent reviewers and differences were resolved by consensus. We assessed the results for heterogeneity in our analysis by examining the forest plots and then calculating a Q statistic, which we compared with the I2 index. If there was no evidence of statistical heterogeneity and pooling of results was clinically appropriate, a combined estimate was obtained using the fixed-effects model; otherwise the random-effects model was used. Results: We identified 11studies involving 3,718 patients. Mean duration of follow-up was 29 months (range 12-62months). Compared with ostial and trunk stenting, distal LMCA PCI was associated with increased MACE (OR 1.95, 95% CI 1.43-2.66) and TLR/TVR (OR 3.13, 95% CI 1.90-5.16).No significant differences were detected for cardiac death (OR 1.06, 95% CI 0.72-1.58, p=0.58), MI (OR 1.15, 95% CI 0.74-1.77, p=0.80) or stent thrombosis (OR 1.57, 95% CI 0.90-2.77, p=0.41). Conclusion: Patients with ostial and trunk LMCA lesions treated with DES have better outcomes than patients with distal lesions. Our findings may support unprotected non-distal LMCA stenting as a primary approach in selected patient subsets.  

Drug eluting stent left main coronary artery coronary artery disease ostiallesion distal lesion

References (25)

  1. 1 Bias in meta-analysis detected by a simple, graphical test [DOI]
  2. 2 Quantifying heterogeneity in a meta‐analysis [DOI]
  3. 3 Meta-analysis of Observational Studies in Epidemiology A Proposal for Reporting [DOI]
  4. 4 Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses [DOI]
  5. 5 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention [DOI]
  6. 6 Guidelines on myocardial revascularization [DOI]
  7. 7 Incidence, Predictors, and Outcome of Thrombosis After Successful Implantation of Drug-Eluting Stents [DOI]
  8. 8 Randomized Study to Evaluate Sirolimus-Eluting Stents Implanted at Coronary Bifurcation Lesions [DOI]
  9. 9 Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation [DOI]
  10. 10 Clinical and Angiographic Outcome After Implantation of Drug-Eluting Stents in Bifurcation Lesions With the Crush Stent Technique [DOI]
  11. 11 Favorable Long-Term Outcome After Drug-Eluting Stent Implantation in Nonbifurcation Lesions That Involve Unprotected Left Main Coronary Artery [DOI]
  12. 12 Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery in Left Main Coronary Artery Disease [DOI]
  13. 13 Distal Left Main Coronary Disease Is a Major Predictor of Outcome in Patients Undergoing Percutaneous Intervention in the Drug-Eluting Stent Era [DOI]
  14. 14 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention [DOI]
  15. 15 Ostial and midshaft lesions vs. bifurcation lesions in 1111 patients with unprotected left main coronary artery stenosis treated with drug-eluting stents: results of the survey from the Italian Society of Invasive Cardiology [DOI]
  16. 16 Three-Year Outcomes After Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease [DOI]
  17. 17 Drug-Eluting Versus Bare-Metal Stents in Unprotected Left Main Coronary Artery Stenosis [DOI]
  18. 18 Long‐term clinical outcomes after drug‐eluting stent implantation in unprotected left main coronary artery disease [DOI]
  19. 19 Long-term follow-up of percutaneous coronary intervention of unprotected left main lesions with drug eluting stents: predictors of clinical outcome [DOI]
  20. 20 Distal Left Main Coronary Bifurcation Lesions Predict Worse Outcome in Patients Undergoing Percutaneous Implantation of Drug-Eluting Stents: Results from the Drug-Eluting Stent for the Treatment of Left Main Disease (DISTAL) Study [DOI]
  21. 21 Unprotected left main stenting in the real world: five-year outcomes of the French Left Main Taxus registry [DOI]
  22. 22 Predictors of restenosis following unprotected left main coronary stenting [DOI]
  23. 23 Unprotected left main disease managed with drug‐eluting stents: Long‐term outcome of 100 patients with increased surgical risk [DOI]
  24. 24 Revascularization of unprotected left main coronary artery disease: Strategy selection and systematic risk assessment [DOI]
  25. 25 Elective implantation of sirolimus-eluting stents for bifurcated and non-bifurcated unprotected left main coronary artery lesions: clinical outcomes at one year [DOI]

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