Asunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Aspirina/administración & dosificación , Procedimientos Quirúrgicos del Sistema Biliar , Enfermedades Cardiovasculares/prevención & control , Colangitis/cirugía , Coledocolitiasis/cirugía , Inhibidores de Agregación Plaquetaria/administración & dosificación , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/antagonistas & inhibidores , Ticlopidina/análogos & derivados , Tirosina/análogos & derivados , Administración Oral , Anciano , Aspirina/efectos adversos , Procedimientos Quirúrgicos del Sistema Biliar/efectos adversos , Enfermedades Cardiovasculares/etiología , Colangitis/etiología , Coledocolitiasis/complicaciones , Clopidogrel , Esquema de Medicación , Quimioterapia Combinada , Humanos , Infusiones Intravenosas , Masculino , Inhibidores de Agregación Plaquetaria/efectos adversos , Ticlopidina/administración & dosificación , Ticlopidina/efectos adversos , Tirofibán , Resultado del Tratamiento , Tirosina/administración & dosificación , Tirosina/efectos adversosRESUMEN
BACKGROUND: Most cardiologists performing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main disease (ULM) mandate mid-term angiographic follow-up, yet there are few data supporting this approach. We aimed to retrospectively compare the outcome of patients with ULM treated with DES according to their follow-up management strategy. METHODS: Patients with ULM stenosis undergoing PCI with DES and surviving up to 6 months were retrospectively identified from our ongoing database. We distinguished those undergoing clinical follow-up only, those with clinically driven angiographic follow-up, and those with routine angiographic follow-up. The primary end-point was the long-term rate of major adverse cardiac events (MACE, i.e., death, myocardial infarction, bypass surgery, or repeat ULM PCI). RESULTS: A total of 198 patients were included: 55 (28%) in the clinical follow-up group, 64 (32%) in the clinically driven angiographic follow-up group, and 79 (40%) in the routine angiographic follow-up group. After 37.0 +/- 15.7 months, mortality was similar in the 3 groups (respectively 7.3, 4.7, and 5.9%, p = 0.27). However, MACE were significantly more common in the clinically driven angiographic follow-up group (42.2 vs. 7.3 and 26.1%, p = 0.02), mainly due to the expected increase in repeat revascularization in those undergoing angiographic follow-up (23.4 vs. 1.8 and 13.14%). Notably, there were no differences in the rate of stent thrombosis across the three groups, with rates of 3.1 vs. 1.8 and 2.5% (p = 0.35). CONCLUSIONS: An expectant management can be safely adopted in most patients with ULM treated percutaneously, as long as a low threshold for control coronary angiography is maintained.
