Twenty Years of Experience in One Thousand De-Novo Left Main Coronary Angioplasty With Angiographic Control in a High-Volume Centre Without On-Site Cardiac Surgery. in Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions / Catheter Cardiovasc Interv. 2025 Mar 18. doi: 10.1002/ccd.31488.

2025
AOU San Luigi di Orbassano
ASL Torino 3

Tipo pubblicazione

Journal Article

Autori/Collaboratori (16)Vedi tutti...

Franzé A
Division of Cardiology, Interventional Unit-Infermi Rivoli Hospital, Turin, Rivoli, Italy.
Zecchino S
San Luigi Gonzaga University Hospital, Turin, Orbassano, Italy.
Tomassini F
Division of Cardiology, Interventional Unit-Infermi Rivoli Hospital, Turin, Rivoli, Italy.

et alii...

Abstract

INTRODUCTION: Given the widespread use of percutaneous coronary intervention (PCI) for the treatment of unprotected left main coronary artery (ULMCA) disease, real-world data are needed to understand the current practice and identify pitfalls and potential benefits, especially for an older and frail population. METHODS: We conducted a retrospective analysis including all patients, namely 1000, who underwent PCI on ULMCA for de-novo lesions, at our high-volume Italian center without on-site cardiac surgery, from 2002 to April 2023. Cases of restenosis, stent thrombosis, and coronary artery bypass grafting (CABG) were excluded. The primary clinical endpoint is major adverse cardiovascular and cerebrovascular event (MACCE), a composite endpoint including all-cause mortality, unplanned revascularization, myocardial infarction and stroke. Secondary clinical endpoints included the individual components of MACCE. Angiographic follow-up data, derived from both elective and clinical-driven procedures, were extensively available. The primary angiographic endpoint is target lesion failure (TLF), defined as significant restenosis or stent thrombosis of the LMCA. We performed a dedicated analysis comparing patients with a protocol-driven elective angiographic follow-up to those without, to evaluate the potential impact of this strategy on clinical outcomes. RESULTS: Our registry encompasses a real-world frail and compromised population, with most patients (75%) presenting with acute coronary syndrome. Angiographic follow-up data were available for 739 patients (73.9%), of whom 612 (82.8%) demonstrated good results of the previous PCI and 127 patients (17.2%) experienced TLF. Multivariate analysis identified insulin-dependent diabetes, moderate to severe renal impairment, and a two-stents bifurcation technique as independent predictors of TLF. Among bifurcation techniques, the highest restenosis rates were observed in the Culotte technique (33.3%), followed by T and protrusion (30%) and Minicrush (28.2%), while the single stent approach was associated with the lowest rate of TLF (12.8%, p?=?