Impact of Residual Chronic Total Occlusion of Right Coronary Artery on the Long-term Outcome in Patients Treated for Unprotected Left Main Disease The Milan and New-Tokyo Registry

被引：24

作者：

Takagi, Kensuke ^{[1
,2
,3
]}

Ielasi, Alfonso

Chieffo, Alaide ^{[1
]}

Basavarajaiah, Sandeep ^{[1
,2
]}

Latib, Azeem ^{[1
,2
]}

Montorfano, Matteo ^{[1
]}

Carlino, Mauro ^{[1
]}

Mizuno, Hiroyuki ^{[1
]}

Hasegawa, Tasuku ^{[1
,2
]}

Godino, Cosmo ^{[1
,2
]}

Figini, Filippo ^{[1
,2
]}

Shannon, Joanne ^{[1
,2
]}

Rezq, Ahmed ^{[1
,2
]}

Ferrarello, Santo ^{[1
]}

Bernelli, Chiara ^{[1
]}

Naganuma, Toru ^{[3
]}

Fujino, Yusuke ^{[3
]}

Nakamura, Sunao ^{[3
]}

Colombo, Antonio ^{[1
,2
]}

机构：

[1] Ist Sci San Raffaele, Intervent Cardiol Unit, I-20132 Milan, Italy

[2] EMO GVM Ctr Cuore Columbus, Intervent Cardiol Unit, I-20145 Milan, Italy

[3] New Tokyo Hosp, Intervent Cardiol Unit, Chiba, Japan

来源：

CIRCULATION-CARDIOVASCULAR INTERVENTIONS | 2013年 / 6卷 / 02期

关键词：

chronic total coronary occlusion; drug-eluting stent; left main coronary artery; right coronary artery; ELUTING STENT IMPLANTATION; BYPASS-SURGERY; SYNTAX TRIAL; INTERVENTION; EUROSCORE; REVASCULARIZATION; PREDICTOR; STENOSIS; SYSTEM; TAXUS;

D O I：

10.1161/CIRCINTERVENTIONS.112.000079

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-The presence of chronic total occlusion of the right coronary artery (CTO-RCA) in patients undergoing percutaneous interventions for unprotected left main (ULM) disease may affect the prognosis. In this study, we evaluated the immediate results and follow-up of patients with ULM-percutaneous interventions and with or without associated CTO-RCA. Methods and Results-Between March 2002 and December 2008, a total of 568 consecutive patients with ULM stenosis treated with drug-eluting stent were included in this analysis. The mean EuroScore and SYNTAX scores were 4.05+/-2.62 and 28.12+/-10.82, respectively. Of these, 522 had ULM lesions without residual CTO-RCA (493 ULM without CTO-RCA+29 ULM with treated CTO-RCA), and 46 patients had residual CTO-RCA. At 1466 days (interquartile range, 1150-1917) follow-up, the cardiac-death occurred in 41 patients (7.2%). Cardiac-death was more frequently observed in patients with ULM and residual CTO-RCA as compared with those without residual CTO-RCA (adjusted hazard ratios, 2.163 [95% confidence interval, 1.018-4.597]; P=0.045). However, target lesion revascularization occurred less frequently in patients with residual CTO-RCA (adjusted hazard ratios, 0.321 [95% confidence interval, 0.13-0.794]; P=0.014), resulting in the similar major adverse cardiovascular events rates between the 2 groups. When we analyzed patients with concomitant ULM and CTO-RCA, cardiac-death was significantly higher in patients with residual as compared with treated CTO-RCA (log-rank P=0.01) despite no difference in baseline characteristics. Conclusions-Cardiac-death occurred more frequently in patients with residual CTO-RCA as compared with those without residual CTO-RCA. These findings suggest that recanalization of CTO-RCA has significant impact on the long-term cardiac-mortality in patients undergoing ULM-percutaneous interventions probably by offering reserve coronary circulation, if in-stent restenosis were to occur in the treated left main.

引用

页码：154 / +

页数：9

共 21 条

[11] The Impact of Right Coronary Artery Chronic Total Occlusion on Clinical Outcome of Patients Undergoing Percutaneous Coronary Intervention for Unprotected Left Main Disease [J].