Original title: The DELTA Registry (Drug-Eluting Stent for Left Main Coronary Artery Disease): A Multicenter registry Evaluating Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for left Main Treatment Reference: Naganuma T, et al. J Am Coll Cardiol Intv 2013;6:1242–9
Angioplasty of the unprotected left coronary trunk has increased significantly in recent years showing good results. Currently the guidelines for angioplasty of ostial lesions and body are classified as a class IIa. In this analysis of DELTA registry, 1612 patients who received angioplasty of the left coronary trunk with drug-eluting stents, were analyzed, in which 482 (29.9 %) had injury to the ostium or body and 1130 (70.1 %) lesion in the distal segment.
The occurrence of combined events (death from any cause, myocardial infarction and revascularization) and stent thrombosis was analyzed. The characteristics of both groups were well balanced with the exception that patients with lesion in the distal segment/bifurcation showed more frequently, multiple vessels lesions a higher SYNTAX score and the need for balloon pump. Those with ostial and body lesion that received greater diameter stents and shorter length.
No difference in the occurrence of intra- hospital events was observed. At follow up of 1250 days (987-1564) 13 final thrombosis (0.8 %) were observed. Angioplasty in the distal segment/bifurcation was associated with a higher incidence of combined events (19.1 % versus 28.5 % HR 1.48, CI 95% 1.16 to 1.89; P = 0.001). This difference was driven mostly by a much greater need for revascularization of the vessel and the target lesion. A tendency to increased all-cause mortality disappeared when matching the two groups with propensity score. When analyzing separately, the group with distal/bifurcation segment lesion, and those receiving 2 stents versus just one had more events. The predictors of events were distal injury/bifurcation, ejection fraction, stent diameter and the need for balloon pump.
Conclusion:
This study shows that the angioplasty for ostial or body of the left coronary trunk has better clinical outcome than the distal/bifurcation segment mainly due to a reduced need for repeat revascularization.
Editorial comment
This registry, like others who evaluated the unprotected trunk angioplasty, showed that it is a safe procedure and that the site of injury is a key point in these results. One of the limitations of this analysis is that first generation drug-eluting stents were used in mostly and, as was usual at the time that the record was made, frequent angiographic follow-up may have increased revascularizations.
Courtesy of Carlos Fava MD.
Fundacion Favaloro
Argentina
Dr. Carlos Fava para SOLACI.ORG