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Outcome of percutaneous coronary intervention with drug-eluting stents in unprotected left main versus non-left main native coronary artery disease: results from the prospective multicenter German DES.DE registry

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Abstract

Background

Unprotected left main coronary artery (ULMCA) disease is considered an indication for surgical revascularization. However, refined percutaneous coronary intervention (PCI) technology and modern drug-eluting stents (DES) render the ULMCA a target for interventional treatment.

Methods and results

Between October 2005 and September 2009, 374 patients receiving DES in ULMCA and 18,678 patients receiving DES in non-left main coronary arteries (nLMCA) with no previous coronary artery bypass graft surgery, were registered at 130 DES.DE sites. The composite of death, myocardial infarction (MI), and stroke defined as major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR) were defined as primary endpoints. Baseline clinical and descriptive morphology of coronary artery disease revealed more comorbidities and more complex anatomies in the ULMCA group. At 1-year follow-up, the ULMCA group suffered from higher rates of overall death (5.6 versus 2.3 %; p < 0.0001), stroke (2.0 versus 0.8 %; p < 0.05), MACCE (8.6 versus 4.9 %; p < 0.01); whereas rates for definite/probable stent thrombosis (2.4 versus 1.6 %; p = 0.29), TVR (14.2 versus 10.8 %; p = 0.06) and MI (1.3 versus 1.9 %; p = 0.44) were not statistically different. These results persisted even after adjustment for different baseline characteristics, except MACCE that was no longer statistically significant.

Conclusion

Data collected in DES.DE revealed that ULMCA PCI with DES result in similar TVR rates as compared to PCI in nLMCA. Moreover, modern DES have not offset the higher comorbidity index and higher procedure-related complication rate with PCI of ULMCA lesions.

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Conflict of interest

All authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Universitätsklinikum Rostock AöR, Rostock, Germany

    I. Akin & C. Nienaber

  2. Elisabeth-Krankenhaus Essen GmbH, Essen, Germany

    C. Naber & G. Sabin

  3. Institut für Herzinfarktforschung, Ludwigshafen, Germany

    M. Hochadel & J. Senges

  4. Asklepios Klinik St. Georg, Hamburg, Germany

    K. H. Kuck

  5. Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany

    G. Richardt & Ralph Tölg

Authors
  1. I. Akin
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  2. C. Naber
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  3. G. Sabin
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  4. M. Hochadel
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  5. J. Senges
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  6. K. H. Kuck
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  7. C. Nienaber
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  8. G. Richardt
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  9. Ralph Tölg
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Corresponding author

Correspondence to Ralph Tölg.

Additional information

For the DES.DE study group.

The members of the German DES.DE Registry are given in the Appendix.

Appendix: Organization of the German DES.DE Registry

Appendix: Organization of the German DES.DE Registry

Members of the Steering Committee: Christoph A. Nienaber (Chairman), Karl-Heinz Kuck (Chairman), Christoph Bode, Fokko de Haan, Gert Richardt, Georg Sabin, Jochen Senges, Sigmund Silber, Jürgen Stumpf, Ulrich Tebbe, Stephan Willich, Thomas Fetsch, Gabriele Sailer, Steffen Schneider.

Members of the Clinical Event Committee: Bernhard Meier, Martin G. Gottwik.

Internet data acquisition (IKKF): Thomas Fetsch, Petra Kremer.

Statistical analysis (IHF): Steffen Schneider, Matthias Hochadel.

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Akin, I., Naber, C., Sabin, G. et al. Outcome of percutaneous coronary intervention with drug-eluting stents in unprotected left main versus non-left main native coronary artery disease: results from the prospective multicenter German DES.DE registry. Clin Res Cardiol 102, 679–686 (2013). https://doi.org/10.1007/s00392-013-0582-1

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  • DOI: https://doi.org/10.1007/s00392-013-0582-1

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