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Long-term results after PCI of unprotected distal left main coronary artery stenosis: the Bifurcations Bad Krozingen (BBK)-Left Main Registry

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Abstract

Aims

Percutaneous coronary intervention (PCI) of unprotected distal left main stenosis (UDLM) is increasingly performed as an alternative to surgical treatment. The optimal strategy for stenting in this setting is still a matter of debate. Therefore, this analysis investigated the long-term clinical outcome of a single- versus a double-stenting strategy for treatment of UDLM.

Methods and results

From a large registry, 867 consecutive patients with UDLM undergoing either single or double stenting with drug-eluting stents (DES) were identified. Follow-up was up to 10 (median 3.1, interquartile range 1.1–5.3) years. Primary endpoint was MACE consisting of all-cause death, myocardial infarction, or target lesion re-intervention (TLR). Secondary clinical endpoints included these single endpoints and stent thrombosis. MACE occurred in 41.5% after single and in 49.0% after double stenting (P = 0.03). TLR was lower after single (17.4%) as compared to double stenting (27.2%; P < 0.01). Between single and double stenting, there were no significant differences for death (26.4 versus 23.3%; P = 0.31), death or myocardial infarction (29.1 versus 27.2%; P = 0.55), or definite/probable stent thrombosis (1.3 versus 2.1%; P = 0.42).

Conclusions

Compared with single stenting, double stenting was associated with a significantly higher long-term risk of MACE. This was driven by a higher incidence of TLR, whereas the risk of death, MI, or stent thrombosis was similar between the two strategies.

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Acknowledgements

We thank doctors from the catheterization laboratory staff for their enthusiasm in supporting the registry; Monika Bockstatt, Rita Höwisch-Pengel, Barbara Steiger and Elke Maurer for dedicated support in data collection.

Funding

No extramural funding was used to support this work. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents.

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Authors and Affiliations

  1. Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany

    Miroslaw Ferenc, Nadja Banholzer, Willibald Hochholzer, Kambis Mashayekhi, Thomas Comberg, Jürgen Rothe, Christian M. Valina, Aurel Toma, Nikolaus Löffelhardt, Michael Gick, Franz-Josef Neumann & Thomas G. Nührenberg

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  1. Miroslaw Ferenc
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Correspondence to Miroslaw Ferenc.

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Conflict of interest

Dr. Ferenc received speaker honoraria from Abbott Vascular, Biotronik, Boston Scientific, Daiichi Sankyo, Medtronic and Terumo. Dr. Hochholzer reports receiving consulting and lecture fees from AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo and the Medicines Company. Dr. Mashayekhi received consulting/speaker honoraria from Abbott Vascular, Asahi Intecc, Biotronik, Boston Scientific, Daiichi Sankyo, Nitiloop, Terumo and Vascular Solutions. The other authors report no conflicts of interest.

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Ferenc, M., Banholzer, N., Hochholzer, W. et al. Long-term results after PCI of unprotected distal left main coronary artery stenosis: the Bifurcations Bad Krozingen (BBK)-Left Main Registry. Clin Res Cardiol 108, 175–184 (2019). https://doi.org/10.1007/s00392-018-1337-9

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