A Meta-analysis of Ostial and Trunk versus Distal Lesions in Unprotected Left Main Coronary Artery Stenting
Journal Title: Cardiology and Angiology: An International Journal - Year 2014, Vol 2, Issue 4
Abstract
Aims: To assess outcomes for percutaneous coronary intervention (PCI) in ostial and trunk versus distal unprotected left main coronary artery (LMCA) lesions in the drug-eluted stent (DES) era. Study Design: A meta-analysis and systematic review. Methods: With the help of a librarian, we searched Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and the Clinical Trials Registry from 2001 to July 2012. We included studies that enrolled ≥ 50 patients and had ≥6 months of follow-up. Our co-primary endpoints were the incidence of major adverse cardiac events (MACE) and target lesion/vessel revascularization (TLR/TVR). Data was abstracted and analyzed by two independent reviewers and differences were resolved by consensus. We assessed the results for heterogeneity in our analysis by examining the forest plots and then calculating a Q statistic, which we compared with the I2 index. If there was no evidence of statistical heterogeneity and pooling of results was clinically appropriate, a combined estimate was obtained using the fixed-effects model; otherwise the random-effects model was used. Results: We identified 11studies involving 3,718 patients. Mean duration of follow-up was 29 months (range 12-62months). Compared with ostial and trunk stenting, distal LMCA PCI was associated with increased MACE (OR 1.95, 95% CI 1.43-2.66) and TLR/TVR (OR 3.13, 95% CI 1.90-5.16).No significant differences were detected for cardiac death (OR 1.06, 95% CI 0.72-1.58, p=0.58), MI (OR 1.15, 95% CI 0.74-1.77, p=0.80) or stent thrombosis (OR 1.57, 95% CI 0.90-2.77, p=0.41). Conclusion: Patients with ostial and trunk LMCA lesions treated with DES have better outcomes than patients with distal lesions. Our findings may support unprotected non-distal LMCA stenting as a primary approach in selected patient subsets.
Authors and Affiliations
Wassef Karrowni, Amandeep S. Dhaliwal, Nader Makki, Ankur Vyas, Amy Blevins, Saadeddine Dughman, Saket Girotra, Peter Cram, Phillip A. Horwitz
Keywords
Related Articles
- EP ID EP344100
- DOI 10.9734/CA/2014/11172
- Views 66
- Downloads 0
Intravascular Imaging-guided Percutaneous Coronary Intervention for Braid-like Coronary Stenosis in a Patient with Prior Myocardial Infarction
A 77-year-old man was admitted to our hospital because of chest oppression on efforts. He had developed an inferior acute myocardial infarction and had undergone percutaneous coronary intervention (PCI) for the right co...
Assessment of a Cardiac Rehabilitation Program Based on the Borg RPE Scale by Six-minute Walk Test: A Pilot Study
Aims: The ability of cardiac rehabilitation to reduce mortality in those with cardiovascular disease is well established. Despite its widespread use in the clinical setting, the Borg Rating of Perceived Exertion (RPE) sc...
Serum Zinc Levels do not Differ in Type 2 Diabetic Subjects with and without Coronary Artery Disease
Aims: The scope of this study is to investigate zinc levels in type 2 diabetic subjects with and without coronary artery disease (CAD). Place and Duration of Study: This study was performed in outpatient clinic of Gener...
Heart Failure with Preserved Ejection Fraction and Therapeutic Approaches: A Systematic Review and Meta-analysis
Aims: Evidence is still lacking regarding optimal treatment for patients with heart failure with preserved ejection fraction (HfPEF). Our objective is to present an individual evaluation for each of the current available...
Correlation of Left Atrial Septal Pouch with the Prevalence of Patent Foramen Ovale: A Retrospective Review
Purpose: To determine the prevalence of Left Atrial Septal Pouch (LASP) and assess the association with Patent Foramen Ovale (PFO). Materials and Methods: We retrospectively reviewed 275 cardiac-gated CT examinations at...