Antonio Colombo Left Main Stenting with DES - summitMD.com
Antonio Colombo Left Main Stenting with DES - summitMD.com
Antonio Colombo Left Main Stenting with DES - summitMD.com
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CENTRO<br />
CUORE<br />
COLUMBUS<br />
ANGIOPLASY SUMMIT 2007<br />
TCT ASIA PACIFIC<br />
Seoul, Korea: 25-27 27 April 2007<br />
Session: <strong>Left</strong> <strong>Main</strong> Summit<br />
<strong>Left</strong> <strong>Main</strong> <strong>Stenting</strong> <strong>with</strong> <strong>DES</strong><br />
15 min<br />
<strong>Antonio</strong> <strong>Colombo</strong><br />
Centro Cuore Columbus Milan, Italy<br />
S. Raffaele Hospital Milan, Italy
CENTRO<br />
CUORE<br />
COLUMBUS<br />
NYS Database<br />
CABG for <strong>Left</strong> <strong>Main</strong> Disease 1997-2000<br />
15<br />
N=16,365<br />
12.8<br />
No exclusions!<br />
12<br />
9<br />
Mortality<br />
rate (%)<br />
6<br />
6.8<br />
9.6<br />
3<br />
0<br />
1 yr 2 yr 3 yr<br />
Death<br />
Ed Hannon, David Faxon: Personal <strong>com</strong>munication to Roxana Mehran<br />
CP1131285-5
CENTRO<br />
CUORE<br />
COLUMBUS<br />
Isolated <strong>Left</strong> <strong>Main</strong> coronary Artery<br />
Stenosis: Long Term Follow-up after<br />
Surgery<br />
13.2%<br />
(14/106)<br />
Total nr Pts<br />
106<br />
8.5%<br />
(9/106)<br />
Elective Surgery<br />
Emergency Surgery<br />
100 (94.4%)<br />
6 (5.6%)<br />
4.7%<br />
(5/106)<br />
Procedural Data<br />
In Hospital<br />
Mortality<br />
Late (5yrs)<br />
Mortality<br />
Overall<br />
Mortality<br />
D’Halonnes et al Heart 2002; 87:544-548<br />
Mortality
CENTRO<br />
CUORE<br />
COLUMBUS<br />
Korean Experience on LMCA<br />
Total 570 pts <strong>with</strong><br />
LMCA disease<br />
255 pts BMS 315 pts <strong>DES</strong><br />
301 pts SES 14 pts PES<br />
Patients treated <strong>with</strong> <strong>DES</strong> were older, , more often diabetics, <strong>with</strong> lower ejection<br />
fraction and more frequently had multivessel disease.<br />
Distal location was more frequent in <strong>DES</strong> (72.4%) as <strong>com</strong>pared <strong>with</strong> BMS (37.8%).<br />
Provisional T stenting was used in 54.8% of <strong>DES</strong>, “crush” technique was used in<br />
19.2%, other two stenting techniques (culotte, Y, etc) were used in 6.9% of the<br />
cases<br />
Data presented ACC 2007
CENTRO<br />
CUORE<br />
Korean Experience on LMCA<br />
COLUMBUS<br />
3 years clinical Follow-Up<br />
20<br />
<strong>DES</strong><br />
BMS<br />
17.6%<br />
15<br />
%<br />
10<br />
ns<br />
ns<br />
ns<br />
7%<br />
5<br />
3.2% 3.9% 0.6% 0.4%<br />
0.6% 1.2%<br />
P=0.001<br />
0<br />
Death MI Stent Trombosis TVR<br />
Data presented ACC 2007
CENTRO<br />
CUORE<br />
COLUMBUS<br />
Palmerini Registry on LMCA<br />
Total 301 pts<br />
<strong>with</strong> LMCA<br />
disease<br />
154 pts CABG<br />
157 pts PTCA<br />
94 pts (60%)<br />
<strong>DES</strong><br />
63 pts (40%)<br />
BMS<br />
Palmerini et al. AJ C 2006
CENTRO<br />
CUORE<br />
COLUMBUS<br />
Palmerini Experience on LMCA<br />
Results at Follow Up<br />
Median follow-up time = 430 days<br />
PTCA Group<br />
CABG Group<br />
P<br />
Pts<br />
157<br />
154<br />
Angiographic FU<br />
104 (66%)<br />
4 (2.6%)<br />
Death<br />
13.4%<br />
12.3 %<br />
ns<br />
Acute MI<br />
8.3%<br />
4.5%<br />
ns<br />
TLR<br />
25.5%<br />
2.6%<br />
0.0001<br />
Patients treated <strong>with</strong> <strong>DES</strong> had a 25% relative risk reduction in the rate<br />
of death, myocardial infarction, , and TLR <strong>com</strong>pared <strong>with</strong><br />
patients treated<br />
<strong>with</strong> BMS.<br />
Palmerini et al. AJ C 2006
CENTRO<br />
CUORE<br />
COLUMBUS<br />
Milan Experience on LMCA<br />
Total 249 pts<br />
<strong>with</strong> LMCA<br />
disease<br />
142 pts CABG<br />
107 pts <strong>DES</strong><br />
87 pts (81.3%)<br />
distal LMCA<br />
77 pts<br />
Bifurcations<br />
10 pts<br />
Trifurcations
CENTRO<br />
CUORE<br />
COLUMBUS<br />
In-Hospital<br />
Pts<br />
Total MI<br />
Q-Wave<br />
MI<br />
Death<br />
CVA<br />
12 months FU<br />
Total MI<br />
Death<br />
Milan Experience on LMCA<br />
MACE<br />
PCI <strong>with</strong> <strong>DES</strong> group<br />
107<br />
10 (9.3%)<br />
0<br />
0<br />
0<br />
CABG Group<br />
142<br />
37 (26.05%)<br />
5 (3.5%)<br />
3 (2.1%)<br />
2 (1.4%)<br />
The rate of angiographic follow-up<br />
was higher in the PCI group<br />
(85%vs. 6% in CABG)<br />
1 (0.9%)<br />
3 (2.8%)<br />
2 (1.4%)<br />
9 (6.4%)<br />
TLR<br />
TVR<br />
15.8%<br />
19.6%<br />
3.6%<br />
3.6%
CENTRO<br />
CUORE<br />
COLUMBUS<br />
Cumulative MACCE at 1 Year<br />
Odds Ratio and Exact 95% CI<br />
PCI better<br />
CABG better
CENTRO<br />
CUORE<br />
COLUMBUS<br />
Cumulative MACCE <strong>with</strong>out<br />
Revascularization at 1 Year<br />
Odds Ratio and Exact 95% CI<br />
PCI better<br />
CABG better
CENTRO<br />
CUORE<br />
COLUMBUS<br />
60%<br />
MACE rate at a median of 10 months<br />
50%<br />
40%<br />
30%<br />
20%<br />
10%<br />
0<br />
0<br />
Carrié et al<br />
Price et al<br />
10%<br />
Migliorini<br />
et al<br />
Chieffo et al<br />
Palmerini<br />
et al<br />
20%<br />
Beta=-0.012 P=0.005<br />
Han<br />
et al<br />
Park<br />
et al<br />
30%<br />
Lozano et al<br />
Wood et al<br />
Lee<br />
et al<br />
Sheiban<br />
et al<br />
40%<br />
Agostoni et al<br />
Christiansen et al<br />
50%<br />
de Lezo<br />
et al<br />
60%<br />
Prevalence of non-bifurcational<br />
ULM<br />
KOMATE<br />
70%
CENTRO<br />
CUORE<br />
COLUMBUS
CENTRO<br />
CUORE<br />
COLUMBUS<br />
IVUS Images Post Rotablator<br />
LAD Os<br />
Cx Os
CENTRO<br />
CUORE<br />
COLUMBUS<br />
• Crush technique: 3.0x33 Cypher in Cx and 3.5x18 Cypher in<br />
LAD.
CENTRO<br />
CUORE<br />
COLUMBUS<br />
Final result after kissing<br />
No restenosis at FU
CENTRO<br />
CUORE<br />
COLUMBUS<br />
Body or Ostial ULM<br />
( No involvement of bifurcation )<br />
144 pts in 5 centers<br />
• 39 PES<br />
• 105 SES<br />
• 19.4% diabetics<br />
• 50% IVUS guidance<br />
• 99% procedural success<br />
75 pts<br />
28 pts<br />
41 pts<br />
2 Milan, 1 Turin, 1 Rotterdam, 1 Korea<br />
Chieffo et al submitted 2007
CENTRO<br />
CUORE<br />
COLUMBUS<br />
Body or Ostial ULM<br />
( No involvement of bifurcation )<br />
75 pts<br />
41 pts<br />
1 year Follow-Up<br />
Angio F-U 100 pts (70%)<br />
death : 1 pt<br />
PCI : 1 pt<br />
CABG : 1 pt<br />
28 pts<br />
Chieffo et al submitted 2007
CENTRO<br />
CUORE<br />
COLUMBUS<br />
Which are the problems <strong>with</strong><br />
ULM stenting <strong>with</strong> <strong>DES</strong><br />
• High risk during index procedure : NO<br />
13.2%<br />
(14/106)<br />
• High risk of MI and death during FU (9/106)<br />
: NO<br />
up to 1 yr and most of pts in double antiplatelet<br />
(5/106)<br />
therapy<br />
Even <strong>with</strong> CABG late deaths do occur<br />
• High restenosis: only focal and Mortality<br />
a potential Mortality<br />
issue<br />
only for distal bifurcations<br />
4.7%<br />
In Hospital<br />
8.5%<br />
Late (5yrs)<br />
Overall<br />
Mortality
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