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Planned angiographic control versus clinical follow‐up for patients with unprotected left main stem stenosis treated with second generation drug‐eluting stents: A propensity score with matching analysis from the FAILS (failure in left main with second generation stents‐Cardiogroup III Study)
Author(s) -
D'Ascenzo Fabrizio,
Iannaccone Mario,
Pavani Marco,
Kawamoto Hiroyoshi,
Escaned Javier,
Varbella Ferdinando,
Boccuzzi Giacomo,
HiddickSmith David,
Colombo Antonio,
Gaita Fiorenzo
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27408
Subject(s) - medicine , mace , clinical endpoint , propensity score matching , myocardial infarction , stent , drug eluting stent , cardiology , target lesion , randomized controlled trial , stenosis , intention to treat analysis , surgery , percutaneous coronary intervention
Background The value of angiographic follow‐up in unprotected left main (ULM) stenting remains undefined. Methods The FAILS‐2 registry included consecutive patients presenting with a critical lesion of an ULM treated with second generation drug eluting stents in 6 centers from June 2007 to January 2015. Patients were stratified into two groups: those discharged with planned angiographic follow‐up and those with clinical follow‐up. MACE (Major Adverse Clinical Events, a composite end point of death, myocardial infarction, TLR, and ST) was the primary end point, while each component was a secondary endpoint Sensitivity analysis was performed for patients treated with a provisional or a two‐stent strategy. A propensity score analysis was used to compare the outcomes in the two groups. Results After multivariate adjustment, 220 patients per group were selected. Planned angiographic follow up was performed after a median of 7 (6–10) months. After 16 (14–21) months, rates of MACE were similar between the two groups (24 vs. 21%, P = 0.29) with lower rates of all cause and cardiovascular death in the angiographic control group (6 vs. 14%, P = 0.01 and 3 vs. 6%, P = 0.04) but with higher rates of TLR (15 vs. 5%, P < 0.001). The same trend was seen irrespective of the stent strategy. Conclusion planned angiographic control results in more TLR but may reduce mortality. These findings need to be confirmed by adequately powered randomized controlled trial.