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)
Contributing authors: Federico Conrotto MD, Alaide Chieffo MD, Roberto di Summa MD, Enrico Cerrato MD, Fabrizio Ugo MD, Pierluigi Omedè MD, Roberto Garbo MD, Antonio Montefusco MD, Giuseppe Biondi-Zoccai MD, Claudio Moretti MD, and Maurizio D'Amico MD
This article was published online on 11 November 2017. An error was subsequently identified in the Author line. This notice is included in the online and print versions to indicate that both have been corrected 16 March 2018.
Abstract
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.
CONFLICT OF INTEREST
None related to this study.
