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G. BIONDI-ZOCCAI 1 , C. MORETTI 1 , E. MELIGA 1 , P. AGOSTONI 2 ,

PREDICTORS OF ADVERSE EVENTS IN PATIENTS WITH UNPROTECTED LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION. G. BIONDI-ZOCCAI 1 , C. MORETTI 1 , E. MELIGA 1 , P. AGOSTONI 2 , A. ABBATE 3 , M. VALGIMIGLI 4 , G. SANGIORGI 5 , G. TREVI 1

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G. BIONDI-ZOCCAI 1 , C. MORETTI 1 , E. MELIGA 1 , P. AGOSTONI 2 ,

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  1. PREDICTORS OF ADVERSE EVENTS IN PATIENTS WITH UNPROTECTED LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION G. BIONDI-ZOCCAI1, C. MORETTI1, E. MELIGA1, P. AGOSTONI2, A. ABBATE3, M. VALGIMIGLI4, G. SANGIORGI5, G. TREVI1 AND I. SHEIBAN1 1University of Turin, Turin, Italy (gbiondizoccai@gmail.com); 2AZ Middelheim, Antwerp, Belgium; 3Virginia Commonwealth University, Virginia, USA; 4University of Ferrara, Ferrara, Italy; 5Emo Centro Cuore Columbus, Milano,Italy

  2. BACKGROUND • Percutaneous drug-eluting stenting (DES) is being increasingly adopted as treatment for selected patients with unprotected left main coronary disease (ULM) • Evidence on predictors of adverse events, pivotal for such patient selection, is lacking to date

  3. OBJECTIVES • To perform a systematic review of the outcomes of DES implantation in patients with ULM coronary disease • To pool major outcomes with meta-analytic techniques • To identify predictors of adverse events by means of meta-regression analysis

  4. METHODS • Several databases (BioMedCentral, clinicaltrials.gov, Google Scholar, and PubMed) were systematically searched for pertinent clinical studies published up to November 2006 • Major selection criteria were: • enrolment of at least 20 patients • follow-up for at least 6 months • full text publication (thus excluding abstracts)

  5. METHODS • Pre-specified subgroup analyses were performed according to ostial ULM, and non-high-risk features (defined by means of Parsonnet or EuroSCORE systems) • Generic-inverse-variance random-effect methods were used to pool incidence rates and adjusted risk estimates (95% confidence intervals) • Meta-regression was performed to identify regression coefficients (with 95% confidence intervals) for event predictors

  6. REVIEW PROFILE

  7. RESULTS • After excluding 806 non-pertinent citations, we finally included 16 original studies (1274 patients, median follow-up 9 months [range 6-24]) • There were 8 uncontrolled reports on DES, 5 non-randomized comparison between DES and bare-metal stents (BMS), and 3 between DES and CABG • Overall, 31% of patients had non-bifurcational ULM and 59.5% had high-risk features at EuroSCORE or Parsonnet

  8. RESULTS • Mid-term MACE occurred in 18.2%, mid-term death in 4.4%, and repeat revascularization in 7.4% • Meta-regression showed that location of disease (ie non-bifurcational vs bifurcational ULM) was the most significant predictor of mid-term MACE (p=0.001) as well as of repeat revascularization (p=0.020)

  9. RESULTS • Intriguingly, disease location explained the vast majority of MACE risk across different patients and studies (R=-0.76, R2=0.58) • On the other hand, high-risk features at EuroSCORE or Parsonnet were the most significant predictor of mid-term death (p=0.027)

  10. RISK OF MACE AT FOLLOW-UP

  11. META-REGRESSION

  12. META-REGRESSION

  13. META-REGRESSION

  14. CONCLUSIONS • Analysis of the largest cohort to date of patients treated with DES for ULM shows that risk-stratification should be based in these patients on location of disease and overall risk features • In particular, event-free survival is excellent in low-risk patients with non-bifurcational ULM, while a high case fatality can be expected in high-risk subjects, irrespective of disease location

  15. For further slides on these topics please feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html

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