PCI with new-generation DES yields positive results for obstructive left main CAD

Patients with unprotected left main coronary artery stenosis who underwent PCI with new-generation drug-eluting stents showed acceptable rates of the composite endpoint of death, MI or cerebrovascular accident over a median follow-up of 17 months, according to the results of the DELTA 2 registry, recently published in JACC: Cardiovascular Interventions.

“Percutaneous treatment of unprotected left main coronary artery disease evolved over time and currently is accepted as an alternative to CABG in selected patients,” Alaide Chieffo, MD, from the interventional cardiology unit at the San Raffaele Scientific Institute in Milan, and colleagues wrote. “In this challenging subset of patients, PCI with DES has been demonstrated to be feasible and safe at midterm clinical follow-up.”

To evaluate the clinical outcomes of unprotected left main coronary artery PCI with new-generation DES in a real-world population, Chieffo and colleagues enrolled 3,986 patients in an international, all-comers multicenter registry.

Patients included in the study had a median age of 69.9 ± 10.9 years.

Diabetes was present in 30.8% of the patients and 21% presented with acute MI.

Using a propensity score stratification, the researchers compared the results of the registry with the DELTA 1 CABG cohort, which was a multicenter registry that evaluated PCI vs. CABG for treatment of patients with left main CAD.

The primary endpoint of the study was the composite of death, MI or stroke at median follow-up time.

At the median 501 days, the primary endpoint was lower in patients in the PCI DELTA 2 group vs. the DELTA 1 CABG group (10.3% vs. 11.6%; adjusted HR = 0.73; 95% CI, 0.55-0.98).

David Kandzari
David E. Kandzari

“Along the storied path of left main clinical studies, the DELTA registry database represents one of the largest surveys of left main PCI in clinical practice and has served a formative role in our understanding of this treatment strategy as it has developed over time,” David E. Kandzari, MD, director of interventional cardiology and chief scientific officer at the Piedmont Heart Institute in Atlanta, and Jeffrey W. Moses, MD, professor of medicine at Columbia University Medical Center, wrote in an accompanying editorial. “Despite its observational design, the analysis is important as it represents one of the largest collective multicenter experiences of left main PCI performed at institutions with skilled operators who have adopted this treatment strategy in routine clinical practice. Second, the study reflects a broad representation of patients with considerable variance in clinical and lesion complexity, many of whom would be systematically excluded from participation in clinical trials.” – by Dave Quaile

Disclosures: Chieffo and Moses report no relevant financial disclosures. Kandzari reports he has received institutional research and grant support from Abbott, Biotronik, Boston Scientific, Medinol, Medtronic, Orbus Neich and St. Jude; and receives honoraria from Biotronik, Boston Scientific, Medtronic and Micell Technologies. Please see the study for all other authors’ relevant financial disclosures.

 

Patients with unprotected left main coronary artery stenosis who underwent PCI with new-generation drug-eluting stents showed acceptable rates of the composite endpoint of death, MI or cerebrovascular accident over a median follow-up of 17 months, according to the results of the DELTA 2 registry, recently published in JACC: Cardiovascular Interventions.

“Percutaneous treatment of unprotected left main coronary artery disease evolved over time and currently is accepted as an alternative to CABG in selected patients,” Alaide Chieffo, MD, from the interventional cardiology unit at the San Raffaele Scientific Institute in Milan, and colleagues wrote. “In this challenging subset of patients, PCI with DES has been demonstrated to be feasible and safe at midterm clinical follow-up.”

To evaluate the clinical outcomes of unprotected left main coronary artery PCI with new-generation DES in a real-world population, Chieffo and colleagues enrolled 3,986 patients in an international, all-comers multicenter registry.

Patients included in the study had a median age of 69.9 ± 10.9 years.

Diabetes was present in 30.8% of the patients and 21% presented with acute MI.

Using a propensity score stratification, the researchers compared the results of the registry with the DELTA 1 CABG cohort, which was a multicenter registry that evaluated PCI vs. CABG for treatment of patients with left main CAD.

The primary endpoint of the study was the composite of death, MI or stroke at median follow-up time.

At the median 501 days, the primary endpoint was lower in patients in the PCI DELTA 2 group vs. the DELTA 1 CABG group (10.3% vs. 11.6%; adjusted HR = 0.73; 95% CI, 0.55-0.98).

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David Kandzari
David E. Kandzari

According to the study, there was an advantage of PCI for cerebrovascular accident (0.8% vs. 2%; aHR = 0.37;95% CI, 0.16-0.86), but there was an advantage of CABG with respect to target vessel revascularization (14.2% vs. 2.9%; aHR = 3.32; 95% CI, 2.12-5.18).

Jeffrey W. Moses

“Along the storied path of left main clinical studies, the DELTA registry database represents one of the largest surveys of left main PCI in clinical practice and has served a formative role in our understanding of this treatment strategy as it has developed over time,” David E. Kandzari, MD, director of interventional cardiology and chief scientific officer at the Piedmont Heart Institute in Atlanta, and Jeffrey W. Moses, MD, professor of medicine at Columbia University Medical Center, wrote in an accompanying editorial. “Despite its observational design, the analysis is important as it represents one of the largest collective multicenter experiences of left main PCI performed at institutions with skilled operators who have adopted this treatment strategy in routine clinical practice. Second, the study reflects a broad representation of patients with considerable variance in clinical and lesion complexity, many of whom would be systematically excluded from participation in clinical trials.” – by Dave Quaile

Disclosures: Chieffo and Moses report no relevant financial disclosures. Kandzari reports he has received institutional research and grant support from Abbott, Biotronik, Boston Scientific, Medinol, Medtronic, Orbus Neich and St. Jude; and receives honoraria from Biotronik, Boston Scientific, Medtronic and Micell Technologies. Please see the study for all other authors’ relevant financial disclosures.