Skip to main content
SpringerLink
Log in

Impact of lesion morphology and associated procedures for left main coronary stenting on angiographic outcome after intervention: sub-analysis of Heart Research Group of Kanazawa, HERZ, Study

  • Original Article
  • Published:
Cardiovascular Intervention and Therapeutics Aims and scope Submit manuscript

Abstract

Whether the lesion morphology and associated interventional procedures for the left main coronary artery disease (LMCA) could affect clinical outcome is still controversial. Therefore, we examined the impact of lesion morphology and associated procedures on clinical and angiographic outcomes of stenting for the LMCA. Among 7,660 patients with coronary intervention registered, we analyzed early angiographic results of 228 patients (179 men, mean age 69.4 years) concerned with LMCA lesions. In 121 out of 228 patients having long-term angiographic results, we examined the occurrence of major adverse coronary events (MACE) particularly in terms of the presence of acute coronary syndrome (ACS), the kind of stents, bear metal or drug eluting, the lesion morphology and associated procedures. Early angiographic success rate of LMCA stenting was 100 %, and clinical success rate was 94.3 %. During follow-up period for 3 years, MACE was observed in 17 patients. Under these conditions, multiple stenting (p < 0.01) and complicated procedures such as such as Y-stent, T-stent and crush stent (p < 0.01) were listed as risks for MACE, although there was no statistical difference in kinds of stent. Multivariate analysis demonstrated the significant disadvantage of complicated procedures using the bear metal stent on the occurrence of MACE (p < 0.01). These results demonstrate that the complicated procedures have great impact on clinical and angiographic outcomes after stenting for LMCA lesions, and suggest the simple procedure with a single stent for LMCA lesions in the present cohort. Whether the presence of ACS can affect the prognosis should further be sought.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Ståhle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW, SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961–72.

    Article  PubMed  CAS  Google Scholar 

  2. Sheiban I, Sillano D, Biondi-Zoccai G, Chieffo A, Colombo A, Vecchio S, Margheri M, Gunn JP, Raina T, Liistro F, Bolognese L, Lee MS, Tobis J, Moretti C. 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). J Am Coll Cardiol. 2009;54:1131–6.

    Article  PubMed  Google Scholar 

  3. Park SJ, Park DW. New era of left main coronary artery treatment strategy. Cardiovasc Interv Ther. 2012;27:1–7.

    Article  PubMed  Google Scholar 

  4. Kimura T, Morimoto T, Furukawa Y, Nakagawa Y, Shizuta S, Ehara N, Taniguchi R, Doi T, Nishiyama K, Ozasa N, Saito N, Hoshino K, Mitsuoka H, Abe M, Toma M, Tamura T, Haruna Y, Imai Y, Teramukai S, Fukushima M, Kita T. Long-term outcomes of coronary-artery bypass graft surgery versus percutaneous coronary intervention for multivessel coronary artery disease in the bare-metal stent era. Circulation. 2008;118:S199–209.

    Article  PubMed  Google Scholar 

  5. Jensen LO, Tilsted HH, Thayssen P, Kaltoft A, Maeng M, Lassen JF, Hansen KN, Madsen M, Ravkilde J, Johnsen SP, Sørensen HT, Thuesen L. Paclitaxel and sirolimus eluting stents versus bare metal stents: long-term risk of stent thrombosis and other outcomes. From the western Denmark heart registry. Euro Interv. 2010;5:898–905.

    CAS  Google Scholar 

  6. Park DW, Kim YH, Yun SC, Lee JY, Kim WJ, Kang SJ, Lee SW, Lee CW, Kim JJ, Choo SJ, Chung CH, Lee JW, Park SW, Park SJ. Long-term outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN medical center-left MAIN revascularization) registry. J Am Coll Cardiol. 2010;56:1366–75.

    Article  PubMed  Google Scholar 

  7. Auer J, Leitner A, Berent R, Lamm G, Lassnig E, Krennmair G. Long-term outcomes following coronary drug-eluting- and bare-metal-stent implantation. Atherosclerosis. 2010;210:503–9.

    Article  PubMed  CAS  Google Scholar 

  8. Lagerqvist B, James SK, Stenestrand U, Lindbäck J, Nilsson T, Wallentin L, SCAAR Study Group. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med. 2007;356:1009–19.

    Article  PubMed  CAS  Google Scholar 

  9. Uchiyama K, Ino H, Hayashi K, Fujioka K, Takabatake S, Yokawa J, Namura M, Mizuno S, Tatami R, Kanaya H, Nitta Y, Michishita I, Hirase H, Ueda K, Aoyama T, Okeie K, Haraki T, Mori K, Araki T, Minamoto M, Oiwake H, Konno T, Sakata K, Kawashiri M, Yamagishi M, Heart Research Group of Kanazawa. Impact of severe coronary disease associated or not associated with diabetes mellitus on outcome of interventional treatment using stents: results from HERZ (Heart Research Group of Kanazawa) analyses. J Int Med Res. 2011;39:549–57.

    Article  PubMed  CAS  Google Scholar 

  10. Nakamura M, Yamagishi M, Ueno T, Hara K, Ishiwata S, Itoh T, Hamanaka I, Wakatsuki T, Sugano T, Kawai K, Kimura T. Current antiplatelet therapy for Japanese patients with ST elevation acute myocardial infarction: J-AMI registry. Cardiovasc Interv Ther. 2013;28:162–9.

    Article  PubMed  CAS  Google Scholar 

  11. Nakao T, Kimura T, Morimoto T, Furukawa Y, Nakagawa Y, Kadota K, Nobuyoshi M, Kita T, Mitsudo K. The long-term efficacy of cilostazol in addition to dual antiplatelet therapy after sirolimus-eluting stent implantation for Japanese patients: an analysis of the 3-year follow-up outcomes from the j-Cypher registry. Cardiovasc Interv Ther. 2012;27:161–7.

    Article  PubMed  CAS  Google Scholar 

  12. Chieffo A, Stankovic G, Bonizzoni E, Tsagalou E, Iakovou I, Montorfano M, Airoldi F, Michev I, Sangiorgi MG, Carlino M, Vitrella G, Colombo A. Early and mid-term results of drug-eluting stent implantation in unprotected left main. Circulation. 2005;111:791–5.

    Article  PubMed  CAS  Google Scholar 

  13. Valgimigli M, van Mieghem CA, Ong AT, Aoki J, Granillo GA, McFadden EP, Kappetein AP, de Feyter PJ, Smits PC, Regar E, Van der Giessen WJ, Sianos G, de Jaegere P, Van Domburg RT, Serruys PW. Short- and long-term clinical outcome after drug-eluting stent implantation for the percutaneous treatment of left main coronary artery disease: insights from the rapamycin-eluting and taxus stent evaluated at Rotterdam Cardiology Hospital registries (RESEARCH and T-SEARCH). Circulation. 2005;111:1383–9.

    Article  PubMed  Google Scholar 

  14. Park SJ, Kim YH, Lee BK, Lee SW, Lee CW, Hong MK, Kim JJ, Mintz GS, Park SW. Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis: comparison with bare metal stent implantation. J Am Coll Cardiol. 2005;45:351–6.

    Article  PubMed  CAS  Google Scholar 

  15. Gao RL, Xu B, Chen JL, Yang YJ, Qiao SB, Li JJ, Qin XW, Yao M, Liu HB, Wu YJ, Yuan JQ, Chen J. Immediate and long-term outcomes of drug-eluting stent implantation for unprotected left main coronary artery disease: comparison with bare-metal stent implantation. Am Heart J. 2008;155:553–61.

    Article  PubMed  CAS  Google Scholar 

  16. Toyofuku M, Kimura T, Morimoto T, Hayashi Y, Shiode N, Okimoto T, Otsuka M, Tamekiyo H, Tamura T, Kadota K, Inoue K, Mitsudo K, j-Cypher Registry investigators. Comparison of target-lesion revascularisation between left main coronary artery bifurcations and left anterior descending coronary artery bifurcations using the one and two stent approach with sirolimus-eluting stents. Euro Interv. 2011;7:796–804.

    Google Scholar 

  17. Toyofuku M, Kimura T, Morimoto T, Hayashi Y, Ueda H, Kawai K, Nozaki Y, Hiramatsu S, Miura A, Yokoi Y, Toyoshima S, Nakashima H, Haze K, Tanaka M, Take S, Saito S, Isshiki T, Mitsudo K, j-Cypher Registry Investigators. Three-year outcomes after sirolimus-eluting stent implantation for unprotected left main coronary artery disease: insights from the j-Cypher registry. Circulation. 2009;120:1866–74.

    Article  PubMed  Google Scholar 

  18. Takagi K, Ielasi A, Shannon J, Latib A, Godino C, Davidavicius G, Mussardo M, Ferrarello S, Figini F, Carlino M, Montorfano M, Chieffo A, Nakamura S, Colombo A. Clinical and procedural predictors of suboptimal outcome after the treatment of drug-eluting stent restenosis in the unprotected distal left main stem: the Milan and New-Tokyo (MITO) registry. Circ Cardiovasc Interv. 2012;5:491–8.

    Article  PubMed  CAS  Google Scholar 

  19. Suzuki N, Kozuma K, Tanabe K, Ikari Y, Muramatsu T, Isshiki T. Clinical and angiographic outcomes after bare metal stents implantation for the patients with acute ST-elevation myocardial infarction: insights from multicenter trials. Cardiovasc Interv Ther. 2010;25:98–104.

    Article  PubMed  Google Scholar 

  20. Nomura A, Yamaji K, Shirai S, Omata F, Soga Y, Nagashima M, Arita T, Ando K, Sakai K, Goya M, Yokoi H, Iwabuchi M, Nobuyoshi M. Very long-term outcomes after percutaneous coronary intervention with bare metal stents for unprotected left main coronary artery disease. Euro Interv. 2012;8:962–9.

    Google Scholar 

  21. Waksman R, Barbash IM, Dvir D, Torguson R, Ben-Dor I, Maluenda G, Xue Z, Satler LF, Suddath WO, Kent KM, Pichard AD. Safety and efficacy of the XIENCE V everolimus-eluting stent compared to first-generation drug-eluting stents in contemporary clinical practice. Am J Cardiol. 2012;109:1288–94.

    Article  PubMed  CAS  Google Scholar 

  22. Kimura T, Morimoto T, Natsuaki M, Shiomi H, Igarashi K, Kadota K, Tanabe K, Morino Y, Akasaka T, Takatsu Y, Nishikawa H, Yamamoto Y, Nakagawa Y, Hayashi Y, Iwabuchi M, Umeda H, Kawai K, Okada H, Kimura K, Simonton CA, Kozuma K, RESET Investigators. Comparison of everolimus-eluting and sirolimus-eluting coronary stents: 1-year outcomes from the Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial (RESET). Circulation. 2012;126:1225–36.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors had no conflicts of interest to declare in relation to this article.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Masa-aki Kawashiri, Kenji Sakata, Katsuharru Uchiyama, Tetsuo Konno, Hidekazu Ino, Kenshi Hayashi & Masakazu Yamagishi

  2. HERZ Group, Kanazawa, Ishikawa, Japan

    Masanobu Namura, Honin Kanaya, Kosei Ueda, Kiyoo Mori, Tsutomu Araki, Masaharu Minamoto & Hisanori Oiwake

  3. HERZ Group, Fukui, Fukui, Japan

    Sumio Mizuno, Ryozo Tatami & Takashi Aoyama

  4. HERZ Group, Toyama, Toyama, Japan

    Yutaka Nitta, Hiroaki Hirase, Kazuyasu Okeie & Tatsuo Haraki

  5. HERZ Group, Yokohama, Kanagawa, Japan

    Ichiro Michishita

Authors
  1. Masa-aki Kawashiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenji Sakata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katsuharru Uchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tetsuo Konno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masanobu Namura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sumio Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ryozo Tatami
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Honin Kanaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yutaka Nitta
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ichiro Michishita
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hiroaki Hirase
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kosei Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Takashi Aoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Kazuyasu Okeie
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Tatsuo Haraki
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Kiyoo Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Tsutomu Araki
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Masaharu Minamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Hisanori Oiwake
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Hidekazu Ino
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Kenshi Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Masakazu Yamagishi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masakazu Yamagishi.

Additional information

M. Kawashiri, K. Sakata and K. Uchiyama equally contributed to establishing the preset work in terms of interventional procedures, case enrollment and data analysis.

Appendix

Appendix

List of affiliated hospitals

Kanazawa Cardiovascular Hospital, Fukui Cardiovascular Center, Maizuru Kyousai Hospital, Ishikawa Prefectural Central Hospital, Toyama Red Cross Hospital, Yokohama Sakae Kyousai Hospital, Takaoka City Hospital, Komatsu Municipal Hospital, Fukui Prefectural Hospital, Koseiren Takaoka Hospital, Kaga Municipal Hospital, Houju Memorial Hospital, Saiseikai Kanazawa Hospital, Kanazawa Social Insurance Hospital, KKR Hokuriku Hospital.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kawashiri, Ma., Sakata, K., Uchiyama, K. et al. Impact of lesion morphology and associated procedures for left main coronary stenting on angiographic outcome after intervention: sub-analysis of Heart Research Group of Kanazawa, HERZ, Study. Cardiovasc Interv and Ther 29, 117–122 (2014). https://doi.org/10.1007/s12928-013-0222-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12928-013-0222-8

Keywords

Search

Navigation