Left Main Coronary Disease Research Articles

Application of levosimendan on percutaneous coronary intervention in patients with ischemic heart failure

Objective To investigate the effects of levosimendan on percutaneous coronary intervention (PCI) in patients with ischemic heart failure. Methods From January 2013 to June 2016, eighty patients with ischemic heart failure undergoing coronary intervention in Pingdingshan People′s Hospital No.1 were randomly divided into treatment group (40 cases) and control group (40 cases). The treatment group was treated with levosimendan on the basis of routine medicine 2 days before operation, and the control group was given routine medication before operation.The baseline clinical data, operative success rate, complications, left ventricular ejection fraction (LVEF%) after 1 month, 6 min walking distance, plasma brain natriuretic peptide (BNP), creatinine and other cardiac and renal functions were observed and compared between the two groups. Results The differences of the baseline clinical characteristics including age (65.5±3.9 vs.63.9±3.6), male (26 cases (65.0%) vs.23 cases (57.5%) ), hypertension (21 cases (52.5%) vs.19 cases (47.5%) ), diabetes (17 cases (42.5%) vs.14 cases (35.0%) ), hyperlipidaemia (30 cases (75.0%) vs.29 cases (72.5%) ), smoking (21 cases (52.5%) vs.19 cases (47.5%) ), COPD (7 cases (17.5%) vs.6 cases (15.0)%), LDL-C ( (4.5±1.0) mmol/L vs.(4.4±1.1) mmol/L), BMI ( (25.9±3.3) vs.(25.6±3.5) ) were not significant (t/χ2=1.30, 0.47, 0.20, 0.47, 0.07, 0.20, 0.09, 0.49, 0.39, P=0.20, 0.49, 0.66, 0.49, 0.80, 0.66, 0.76, 0.63, 0.70). There was no significant difference in coronary artery lesion between two groups, including single vessel lesion (11 cases (27.5%) vs.15 cases (37.5%) ), double vessel lesion ( (22 cases (55.0%) vs.19 cases (47.5%) ), three vessel lesion ( (7 cases (17.5%) vs.6 cases (15.0%) ) and left main coronary artery disease (7 cases (17.5%) vs.6 cases (15.0%) ) (Z=-0.88, P=0.38). The time of percutaneous coronary intervention ( ( 51.0±8.6) min vs.(49.6±9.6) min), the time of X-ray exposure ( (20.3±7.0) min vs.(18.4±5.6) min), material consumption ( (123.2±16.6) ml vs.(117.3±25.1) ml) between two groups have no difference (t/χ2=0.70, 1.39, 1.24, P=0.49, 0.17, 0.22). There were significant differences between the two groups in the success rate of operation (38 cases (95.0%) vs.31cases (77.5%), heart failure (1 cases (2.5%) vs.6cases (15.0%) ) and complications (2 cases (5.0%) vs.11 cases (27.5%) ) (χ2=5.17, 3.91, 7.44, P=0.02, <0.05, <0.01). Compared with the control group, the treatment group had greater advancement in LVEF, 6 min walking distance, BNP and creatinine level at one month after operation (F=6.10, 63.60, 51.00, 348.00, P=0.02, <0.01, <0.01, <0.01). Conclusion Levosimendan can effectively improve the heart function and renal function, improve the success rate of PCI in patients with ischemic heart failure and reduce the incidence of complications. Key words: Percutaneous coronary intervention; Levosimendan; Ischemic heart failure

3120Long-term outcomes of different two-stenting bifurcation techniques for unprotected left main coronary bifurcation disease: a FAILS-2 substudy

3120Long-term outcomes of different two-stenting bifurcation techniques for unprotected left main coronary bifurcation disease: a FAILS-2 substudy

P530Restenosis in simultaneous kissing stents to treat unprotected left main stem coronary artery bifurcation disease: incidence and management

P530Restenosis in simultaneous kissing stents to treat unprotected left main stem coronary artery bifurcation disease: incidence and management

P2071Single- vs two- stenting technique with second generation drug eluting stent for unprotected left main coronary bifurcation disease: insights from FAILS-2 study

P2071Single- vs two- stenting technique with second generation drug eluting stent for unprotected left main coronary bifurcation disease: insights from FAILS-2 study

Poor long-term outcomes in stroke patients with asymptomatic coronary artery disease in heart CT

Background and aimsAlthough stroke patients have a high risk of ischemic heart disease, little information is available on the risk of coronary events in stroke patients with asymptomatic coronary artery disease (CAD). We investigated the long-term vascular outcomes in stroke patients with asymptomatic CAD diagnosed with multi-detector coronary computed tomography (MDCT). MethodsThis study was a retrospective analysis using a prospective cohort of ischemic stroke patients. We included consecutive stroke patients without history or symptoms of CAD who underwent MDCT. We investigated the long-term risk of major adverse cardiovascular events (MACE: cardiovascular mortality, ischemic stroke, myocardial infarction, unstable angina, and urgent coronary revascularization) and composite of MACE/all-cause mortality/elective coronary revascularization. We further investigated the value of MDCT for MACE prediction. ResultsAmong the 1893 included patients, 1349 (71.3%) patients had some degree of CAD and 654 patients (34.5%) had significant (≥50%) CAD. At follow-up (median, 4.4 years), MACE occurred in 230 patients (12.2%). Event rates of MACE increased with the increasing extent of CAD. After adjustment for age, sex, and risk factors, the hazard ratios for MACE in mild CAD, 1-VD, 2-VD, and 3-VD or left main coronary disease were 1.28 (95% confidence interval [CI]: 0.88–1.87), 1.39 (95% CI: 0.90–2.16), 2.22 (95% CI: 1.39–3.55), and 2.91 (95% CI: 1.82–4.65), respectively (no CAD as a reference). Diagnosis of asymptomatic CAD significantly improved the prediction of MACE. ConclusionsAsymptomatic CAD detected on MDCT was associated with increased risks of vascular events or deaths in acute stroke patients.

Efficacy of early protective pulmonary ventilation and intra-aortic balloon pump combined with primary percutaneous coronary intervention in treating patients with acute myocardial infarction complicated with cardiogenic shock and hypoxemia

Objective To investigate the clinical efficacy and prognosis of early protective pulmonary ventilation and intra-aortic balloon pump(IABP)combined with percutaneous coronary intervention(PCI)in treating patients with acute myocardial infarction(AMI)complicated with cardiogenic shock(CS)and hypoxemia. Methods The 49 patients diagnosed as AMI complicated with CS and hypoxemia and treated with early protective pulmonary ventilation and IABP combined with PCI in Tianjin Chest Hospital from January 2015 to December 2015 were retrospectively analyzed.Major adverse cardiovascular events(MACE)including sudden cardiac death, recurrent myocardial infarction, heart failure and development of target vessel revascularization were recorded during one year of follow-up visits.Survival rate was analyzed and Cox regression analysis was used to explore risk factors for occurrence of MACE after the treatment. Results The revascularization of target vessel was successfully operated on all of the 49 patients.The mean time from attack to hospitalization was(6.2±1.5)hours, while the mean time from emergency room to balloon dilatation was(118.55±28.28)minutes.In these patients, 30(61.2%)cases were diagnosed as STEMI, among which 23(76.6%)cases as anterior wall myocardial infarction and 5(16.7%)cases as inferior wall myocardial infarction.While the other 19(38.8%)cases were diagnosed as non-STEMI.Using coronary arteriography, 46(93.9%)cases had multi-vessel coronary artery disease, among which 13(26.5%)cases were complicated with severe left main coronary artery disease and 27(55.1%)cases had severe vascular calcification.44(89.8%)cases had TIMI perfusion grade 3 blood flow after PCI, while 5(10.2%)cases did not achieve TIMI grade 3 blood flow.One(2.0%)case had serious complications and 12(24.5%)patients died in hospital.31(63.3%)patients survived 1 year during follow-up visits.Total number of MACE was 32(65.3%). Among these events, 18(36.7%)died, 4 cases(8.2%)had recurrent myocardial infarction, 13 cases(26.5%)had heart failure(HF)and 5 cases(10.2%)had target vessel revascularization(TVR). The total event-free survival rate was 34.7%.Multivariable Cox regression analysis showed that severe vascular calcification〔HR(95%CI): 2.677(1.184-6.054), P=0.018〕, TIMI grade blood flow less than level 3 after PCI〔HR(95%CI): 26.289(6.314-109.470), P=0.000〕and more than 120 minutes from emergency room to balloon dilatation〔HR(95%CI): 2.923(1.325-6.446), P=0.008〕were risk factors for MACE. Conclusions Early protective pulmonary ventilation and IABP combined with emergency PCI are safe and effective for treatment of patients with AMI complicated with CS and hypoxemia.The pattern of treatment can significantly decrease death rate and increase 1-year survival rate. Key words: Myocardial infarction; Shock cardiogenic; Pulmonary ventilation; Angioplasty, transluminal, percutaneous coronary

Incidence, predictors, clinical profile, management and outcome of patients with isolated left main coronary artery ostial disease

ObjectivesIsolated left main coronary artery (LMCA) ostial disease is a rare variant of LMCA disease. Earlier studies on this disease are limited by small number of patients enrolled. The aim of the present study was to analyze the incidence, risk factors, clinical profile and long term outcome of patients with isolated LMCA ostial disease. Methods15,553 patients who underwent coronary angiogram in a single tertiary care cardiac hospital were analyzed for LMCA disease. 351(2.2%) patients were found to have significant LMCA disease out of which 28(0.18%) had isolated LMCA ostial disease. These 28 patients were compared with 323 non-ostial and non-isolated LMCA disease patients. ResultsThe mean age of isolated LMCA ostial disease group was significantly less than the other group (p=0.009). Females were more affected than males (p=0.008). They also had low incidence of coronary risk factors (especially dyslipidemia, p=0.04). They tend to present more with stable angina and less with myocardial infarction. They had higher ejection fraction and normal regional wall motion (p=0.04). There was no mortality difference between two groups at the end of 1 year (p=0.234). ConclusionIn one of the largest studies done in these patients, we found that isolated LMCA ostial disease is more common in middle aged females with few coronary risk factors. These patients also had a better ejection fraction and normal regional wall motion compared to patients with non-ostial and non-isolated LMCA disease. The clinical and angiographic profile of these patients suggests that they may represent a distinct clinical entity.

Percutaneous coronary intervention vs coronary artery bypass grafting for left main coronary artery disease? A systematic review and meta-analysis of randomized controlled trials.

It is not clear whether percutaneous coronary intervention (PCI) is as effective and safe as coronary artery bypass grafting (CABG) for left main coronary artery disease. We aimed to perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that compared PCI and CABG in left main coronary disease. We searched PubMed, EMBASE, Cochrane, Scopus and relevant references for RCTs (inception through, November 20, 2016 without language restrictions) and performed meta-analysis using random-effects model. All-cause mortality, myocardial infarction, revascularization rate, stroke, and major adverse cardiac and cerebrovascular events (MACCE) were the measured outcomes. Six RCTs with a total population of 4700 were analyzed. There was no difference in all-cause mortality at 30-day, one-year, and five-year (1.8% vs 1.1%; OR 0.60; 95% CI: 0.26-1.39; P=.23; I2 =9%) follow-up between PCI and CABG. CABG group had less myocardial infarction (MI) at five-year follow-up than PCI (5% vs 2.5%; OR 2.04; CI: 1.30-3.19; P=.002; I2 =1%). Revascularization rate favored CABG in one-year (8.6% vs 4.5%; OR 2; CI: 1.46-2.73; P<.0001; I2 =45%) and five-year (15.9% vs 9.9%; OR 1.73; CI: 1.36-2.20; P<.0001; I2 =0%) follow-up. Although stroke rate was lower in PCI group at 1year, there was no difference in longer follow-up. MACCE at 5years favored CABG (24% vs 18%; OR 1.45; CI: 1.19-1.76; P=.0001; I2 =0%). On subgroup analysis, MACCE were not different between two groups in low-to-intermediate SYNTAX group while it was higher for PCI group with high SYNTAX group. Percutaneous coronary intervention could be as safe and effective as CABG in a select group of left main coronary artery disease patients.

Coronary artery bypass graft surgery versus percutaneous coronary intervention with drug-eluting stents for left main coronary artery disease: A meta-analysis of randomized trials

BackgroundDespite several clinical studies, efficacy of coronary artery bypass grafting (CABG) surgery versus percutaneous coronary intervention (PCI) in patients with left main (LM) disease remains controversial. The objective of this meta-analysis of randomized trials was to evaluate the clinical outcome of CABG versus PCI with drug-eluting stents in LM coronary disease. MethodsWe systematically searched online databases up to March 2017 for randomized trials comparing CABG to PCI with drug-eluting stents. We calculated odds ratios (ORs) and 95% confidence intervals (CIs). ResultsWe included data from 5 randomized trials and 4595 patients. At 30days, CABG was associated with higher stroke (OR 2.54 [95% CI, 1.02–6.31]) and periprocedural myocardial infarction (OR 1.45 [95% CI, 1.00–2.10]), with no other significant differences compared to PCI. At 1year, CABG reduced repeat revascularization (OR 0.56 [95% CI, 0.40–0.77]), but increased stroke (OR 5.11 [95% CI, 1.62–16.12]). At 3–5years, CABG reduced repeat revascularization (OR 0.55 [95% CI, 0.45–0.67]) and non-periprocedural myocardial infarction (OR 0.45 [95% CI, 0.29–0.70]), without significant differences on other outcomes. ConclusionsFrom the present updated meta-analysis of available studies on LM coronary disease treatment, there were no differences in mortality, myocardial infarction, and stroke rate at 3–5years follow-up after CABG or PCI, but CABG decreased the rate of repeat revascularization and non-periprocedural infarction. However, at short-term follow-up, CABG showed higher rate of stroke and periprocedural myocardial infarction, but these effects attenuated over time. These findings merit further investigation at longer follow-up.

The synergy between percutaneous coronary intervention with TAXUS and cardiac surgery study: A surgical perspective

he SYNTAX (The Synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) study is an important study to indicate the best treatment option for patients who have three vessel coronary artery disease and/or left main stem coronary disease (LMD). CABG (coronary artery bypass grafting) is still the preferred therapy for these patient groups with proven low mortality and excellent long term survival rates. PCI-DES (percutaneous coronary intervention with drug eluting stents) is a relative non-invasive procedure with comparable short and medium term survival, but with a much higher repeat revascularisation rate. The SYNTAX Study enrolled 1800 patients in a randomised arm and 1275 in a registry arm. A SYNTAX Score was developed to assess the lesion morphology. At 12 months follow-up in the randomised group there was an increased death rate (4.3% vs 3.5%), myocardial infarction rate (4.8% vs 3.2%) and repeat revascularisation rate (13.7% vs 5.9%) in the PCI-TAXUS (percutaneous coronary intervention with TAXUS stent) group compared to the CABG group. This trend continues up to 24 months with increased death rate (6.2% vs 4.9%), myocardial infarction rate (5.9% vs 3.3%), repeat procedure rate (17.4% vs 8.6%) and MACCE rate (23.4% vs 16.3%) in the PCI group compared to the CABG group. The aim of the SYNTAX Study was to prove non-inferiority of PCI (percutaneous coronary intervention) compared to CABG in these patient populations. Non-inferiority of PCITAXUS compared to CABG in this study population could not be shown at 12 or 24 months. The cerebrovascular event rate was higher in the CABG group in both study arms (2.2% vs 0.6%) in the first year, but a nearly similar CVA rate during the next 12 months. The study will terminate in 2011 and will give much-needed information regarding the optimal treatment option in patients with three vessel disease and/or left main disease.

Meta-analysis of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease

Despite the increase in use of percutaneous coronary intervention (PCI) in left main coronary disease, its efficacy compared with coronary artery bypass grafting (CABG) is unclear. We performed a meta-analysis of randomized controlled trials to assess the optimal revascularization strategy. Our search yielded 8 studies reporting relevant outcomes that were pooled using the inverse variance method, and the hazard ratio (HR) was calculated. The primary outcome was all-cause mortality, myocardial infarction (MI), or stroke (major adverse cardiac events [MACE]), and the secondary outcome was death/MI/stroke/repeat revascularization (expanded MACE). Differences in outcomes classified by follow-up duration (early: 0 to 1year; late: 3 to 5years) or anatomical complexity of coronary artery disease (SYNTAX score) were investigated. Our results suggest no difference in either early or late MACE (early: HR 0.81; 95% confidence interval [CI] 0.63 to 1.05; late: HR 1.12; 95% CI 0.80 to 1.56) or expanded MACE (early: HR 1.03; 95% CI 0.69 to 1.52; late: HR 1.16; 95% CI 0.95 to 1.43) between the 2 groups. There was an increased risk of expanded MACE with a high SYNTAX score for PCI (HR 1.47; 95% CI 1.13 to 1.92) at late follow-up. There were comparable rates of all-cause mortality and nonprocedural MI between the 2 groups with increased rates of repeat revascularization with PCI throughout the follow-up and higher rates of stroke with coronary artery bypass grafting early in the follow-up period. In conclusion, our analysis suggests that CABG may be preferable in patients with left main disease and high SYNTAX scores, assuming they are at low surgical risk, and PCI may be an acceptable alternative in patients with low-intermediate SYNTAX scores.

Percutaneous coronary intervention or coronary artery bypass grafting for unprotected left main coronary artery disease.

Recent trials comparing PCI with CABG for unprotected left main disease yielded discrepant evidence. To perform an updated meta-analysis of randomized trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease. Randomized trials comparing PCI versus CABG for patients with unprotected left main coronary artery disease were included. Summary estimates risk ratios (RRs) were performed with a DerSimonian and Laird model at short-term, intermediate and long-term follow-up periods (i.e., 30-days, 1-year, and >1-year). Outcomes evaluated were major adverse cardiac and cerebrovascular events (MACCE), all-cause mortality, myocardial infarction, stroke, revascularization and stent thrombosis or symptomatic graft occlusion. Six trials with 4,700 patients and a mean SYNTAX score of 23 were included. At short-term follow-up, the risk of MACCE was lower with PCI (RR 0.55, 95% confidence interval [CI] 0.39-0.76) driven by the lower risk of myocardial infarction (RR 0.67, 95% CI 0.46-0.99), and stroke (RR 0.38, 95% CI 0.16-0.90). The risk of MACCE was similar at the intermediate follow-up (RR 1.21, 95% CI 0.97-1.51). At long-term follow-up, PCI was associated with a higher risk of MACCE (RR 1.19, 95% CI 1.01-1.41), due to a higher risk of revascularization (RR 1.62, 95% CI 1.34-1.94), while the risk of all-cause mortality, myocardial infarction, and stroke were similar. In patients with unprotected left main coronary disease and low to intermediate SYNTAX score, PCI might be an acceptable alternative to CABG. © 2017 Wiley Periodicals, Inc.

Coronary Artery Bypass Grafting With and Without Manipulation of the Ascending Aorta: A Network Meta-Analysis

BackgroundCoronary artery bypass grafting (CABG) remains the standard of treatment for 3-vessel and left main coronary disease, but is associated with an increased risk of post-operative stroke compared to percutaneous coronary intervention. It has been suggested that CABG techniques that eliminate cardiopulmonary bypass and reduce aortic manipulation may reduce the incidence of post-operative stroke. ObjectivesA network meta-analysis was performed to compare post-operative outcomes between all CABG techniques, including anaortic off-pump CABG (anOPCABG), off-pump with the clampless Heartstring device (OPCABG-HS), off-pump with a partial clamp (OPCABG-PC), and traditional on-pump CABG with aortic cross-clamping. MethodsA systematic search of 6 electronic databases was performed to identify all publications reporting the outcomes of the included operations. Studies reporting the primary endpoint, 30-day post-operative stroke rate, were included in a Bayesian network meta-analysis. ResultsThere were 13 included studies with 37,720 patients. At baseline, anOPCABG patients had higher previous stroke than did the OPCABG-PC (7.4% vs. 6.5%; p = 0.02) and CABG (7.4% vs. 3.2%; p = 0.001) patients. AnOPCABG was the most effective treatment for decreasing the risk of post-operative stroke (–78% vs. CABG, 95% confidence interval [CI]: 0.14 to 0.33; –66% vs. OPCABG-PC, 95% CI: 0.22 to 0.52; –52% vs. OPCABG-HS, 95% CI: 0.27 to 0.86), mortality (–50% vs. CABG, 95% CI: 0.35 to 0.70; –40% vs. OPCABG-HS, 95% CI: 0.38 to 0.94), renal failure (–53% vs. CABG, 95% CI: 0.31 to 0.68), bleeding complications (–48% vs. OPCABG-HS, 95% CI: 0.31 to 0.87; –36% vs. CABG, 95% CI: 0.42 to 0.95), atrial fibrillation (–34% vs. OPCABG-HS, 95% CI: 0.49 to 0.89; –29% vs. CABG, 95% CI: 0.55 to 0.87; –20% vs. OPCABG-PC, 95% CI: 0.68 to 0.97), and shortening the length of intensive care unit stay (–13.3 h; 95% CI: –19.32 to –7.26; p < 0.0001). ConclusionsAvoidance of aortic manipulation in anOPCABG may decrease the risk of post-operative stroke, especially in patients with higher stroke risk. In addition, the elimination of cardiopulmonary bypass may reduce the risk of short-term mortality, renal failure, atrial fibrillation, bleeding, and length of intensive care unit stay.

Repeat the Electrocardiogram!

A 71-year-old diabetic woman with intermittent chest pain and left bundle branch block was admitted to the hospital for further assessment. A repeat electrocardiogram showed new anterior T-wave inversions concordant with the QRS complexes. Thus, she had myocardial ischemia, and coronary arteriography revealed left main and triple vessel coronary disease. She went for urgent coronary artery bypass operation.

Stenting of the Left Main Artery Is Noninferior to Bypass Surgery

Unprotected left main (LM) coronary artery disease (CAD) has traditionally been treated surgically with coronary-artery bypass grafting (CABG),

Outcomes After Percutaneous Coronary Intervention or Bypass Surgery in Patients With Unprotected Left Main Disease

BackgroundCurrently available randomized data on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for the treatment of unprotected left main coronary disease (LMD) lacks statistical power due to low numbers of patients enrolled. ObjectivesThis study assessed long-term outcomes of PCI and CABG for the treatment of LMD in specific subgroups according to disease anatomic complexity. MethodsWe conducted a pooled analysis of individual patient-level data of the LMD patients included in the PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) and SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) trials. Incidences of major adverse cardiac events were assessed at 5 years follow-up. ResultsStudy population comprised 1,305 patients. The incidence of major adverse cardiac and cerebrovascular events at 5 years was 28.3% in the PCI group and 23.0% in the CABG group (hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.01 to 1.55; p = 0.045). This difference is mainly driven by a higher rate of repeat revascularization associated with PCI (HR: 1.85; 95% CI: 1.38 to 2.47; p < 0.001). The 2 strategies showed similar rates of the safety composite endpoint of death, myocardial infarction, or stroke (p = 0.45). In patients with isolated LM or LM + 1-vessel disease, PCI was associated with a 60% reduction in all-cause mortality (HR: 0.40; 95% CI: 0.20 to 0.83; p = 0.029) and 67% reduction in cardiac mortality (HR: 0.33; 95% CI: 0.12 to 0.88; p = 0.025) when compared with CABG. ConclusionsIn patients with unprotected LMD, CABG, and PCI result in similar rates of the safety composite endpoint of death, myocardial infarction, or stroke. In patients with isolated LM or LM + 1-vessel disease, PCI is associated with lower all-cause and cardiac mortality when compared to CABG.

Relation of Plasma Lipoprotein(a) to Subclinical Coronary Plaque Volumes, Three-Vessel and Left Main Coronary Disease, and Severe Coronary Stenoses in Apparently Healthy African-Americans With a Family History of Early-Onset Coronary Artery Disease

Serum lipoprotein(a) [Lp(a)] is a coronary artery disease (CAD) risk factor in persons of European ancestry. Levels are twofold to threefold higher in African-Americans (AAs), but reported associations with CAD have been inconsistent. The relation of Lp(a) with the extent and severity of subclinical coronary plaque has not been described in AAs. We screened 269 apparently healthy AAs for risk factors and coronary plaque using advanced coronary computed tomographic angiography. Total coronary plaque (TCP), noncalcified coronary plaque, and calcified coronary plaque volumes (mm(3)) were quantified using a validated automated method. Lp(a) was measured by ELISA. Multivariable modeling was performed with adjustment for traditional CAD risk factors and intrafamilial correlations. Mean age was 51 ± 11years and 64% were female. Plaque was present in 41%. Lp(a) was independently associated with TCP volume [log(TCP+ 1)] (p= 0.04), 3-vessel and/or left main involvement (p= 0.04), and at least 1 stenosis >50% (p= 0.006). Best-fit regression analyses showed that subjects with Lp(a) >40mg/dl were threefold more likely to have 3-vessel and/or left main disease (95% confidence interval 1.4 to 6.8, p= 0.005) and fourfold more likely to have stenosis >50% (95% confidence interval 1.3 to 15.0, p= 0.02). In subjects with plaque (n= 110), multivariable models showed the Lp(a) level was significantly and independently associated with TCP (p= 0.009), noncalcified coronary plaque (p= 0.01), and calcified coronary plaque (p= 0.003) and affected vessel length (p= 0.01). In conclusion, high Lp(a) is strongly associated with coronary plaque volumes, extent, and severity in apparently healthy AAs. High levels of Lp(a) may be particularly important in the pathogenesis of CAD in AAs.

EuroScore and our risk-prediction model for surgical mortality of coronary artery bypass grafting for coronary artery left-main disease

EuroScore and our risk-prediction model for surgical mortality of coronary artery bypass grafting for coronary artery left-main disease

The European Bifurcation Club Left Main Study (EBC MAIN): rationale and design of an international, multicentre, randomised comparison of two stent strategies for the treatment of left main coronary bifurcation disease

Our aim is to investigate clinical outcomes following single versus dual stenting strategies for the treatment of true bifurcation distal left main coronary artery lesions. The EBC MAIN study is a prospective, multinational, randomised clinical study of left main stem true bifurcation lesions (type 1,1,1 or 0,1,1: both left anterior descending and circumflex artery >2.75 mm diameter). The study hypothesis is that left main coronary bifurcation lesions are best treated with a planned single-stent strategy rather than a planned dual-stent strategy, with respect to death, target lesion revascularisation and myocardial infarction at one year. A total of 450 patients will be enrolled and treated either with a planned single or a planned dual zotarolimus-eluting stent strategy according to randomisation. The primary study endpoint is a composite of death, myocardial infarction and target lesion revascularisation at 12 months. Secondary endpoints are: death, myocardial infarctions, and target lesion revascularisation, each at 12 months; angina status, stent thrombosis, death, myocardial infarction, target lesion revascularisation at three- and five-year clinical follow-up. EBC MAIN will be the first randomised clinical trial to compare single versus dual stenting strategies for the treatment of true bifurcation distal left main coronary artery lesions.

TCTAP A-047 Percutaneous Coronary Intervention Versus Coronary-Artery Bypass Grafting for Left Main Coronary Disease with Reduced Left Ventricular Ejection Fraction

TCTAP A-047 Percutaneous Coronary Intervention Versus Coronary-Artery Bypass Grafting for Left Main Coronary Disease with Reduced Left Ventricular Ejection Fraction