AS-034 Multivessel and Left Main Coronary Artery Stenting in Comparison with Surgical Revascularization in Patients with Non ST Elevation Acute Coronary Syndrome (The MILESTONE Registry)

April 24 –27, 2012

O R A L A B S T R A C T S

events (MAVE), including death, Q-wave myocardial infarction, and stroke. Results: The incidences of 5-year MAVE according to the GRC were 5.4% in the low, 13.5% in the intermediate, 43.8% in the high risk group (p⬍0.001) after PCI and 7.3% in the low, 15.6% in the intermediate, 36.0% in the high risk group (p⬍0.001) after CABG. The MAVE rates according to the SYNTAX score were 6.0% in the lowest (⬍23), 9.6% in the intermediate (23⬃32), 23.2% in the highest (⬎32) score group (p⬍0.001) after PCI. However, after CABG, the MAVE rate (14.8%) of the lowest SYNTAX score group was higher than that (9.6%) of the intermediate score group (20.8% in the highest score group, p⫽0.04). The C-indexes of GRC and SYNTAX score were 0.704 and 0.671 in the PCI group, 0.638 and 0.566 in the CABG group, respectively. Conclusion: For patient with unprotected LMCA disease, the GRC showed a significantly improved predictive ability as compare with SYNTAX score after percutaneous or surgical revascularization.

AS-033 Midterm Clinical and QCA Analysis of the Branch in Left Main Bifurcation Lesion after Cross over Single Stent Strategy: Comparison with or without Final Kissing Balloon Technique(KBT). kisaki Amemiya, Takenori Domei, Masahi Iwabuchi, Hiroyoshi Yokoi, Masakiyo Nobuyochi. Kokura memorial hospital, Kitakyusyu, Japan. Background: Midterm clinical and angiographic outcomes at a side banch for patients with unprotected left main coronary artery (LM) bifurcation desease after crossover stenting from the left anterior descending coronary artery (LAD) to the left main artery have not yet been fully clarified. Moreover, the efficacy of final kissing balloon technique to side branch for side branch without significant stenosis have not been fully evaluated. The aim of this study was to evaluate clinical and angiographic outcome of cross over single stent strategy for LM bifurcation, and the efficacy of final kissing balloon technique for LM side branch without significant stenosis.

Methods: To evaluate midterm outcome, clinical and angiographic follow-up information was analyzed in a total of 74 unprotected LM bifurcation cases (KBT; 33, non-KBT; 44 cases) with successful stenting in unprotected LM bifurcation lesions from the left main into the LAD.

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To evaluate the efficacy of final kissing balloon technique for side branch, quantitative coronary angiographic analysis (QCA analysis) was performed at pre and post index procedure, 6 month and 12 month follow up. Results: Clinical events; cardiac death, myocardial infarction and TLR, were less likely observed in KBT group (p⫽0.05). In QCA analysis in cases without TLR, acute gain at side branch was better in KBT group and this angiographic efficacy seemed to be sustained at midterm of follow-up, but statistical significant difference cannot be held. Conclusion: KBT was feasible to treat unprotected LM bifurcation with cross over single stent strategy.

AS-034 Multivessel and Left Main Coronary Artery Stenting in Comparison with Surgical Revascularization in Patients with Non ST Elevation Acute Coronary Syndrome (The MILESTONE Registry). Pawel E Buszman1, Piotr P Buszman1, Andrzej Bochenek2, Marek Król1, Marek Kondys1, Bodgan Gorycki1, Janusz Prokopczuk1, R. Stefan Kiesz3, Marek Gierlotka4, Marian Zembala4, Lech Polon´ski4. 1American Heart of Poland, Katowice, Poland; 2Upper Silesian Heart Center, Katowice, Poland; 3 San Anotnio Endovascular and Heart Institute, San Antonio, USA; 4 Silesian Center for Heart Diseases, Zabrze, Poland. Background: Surgical myocardial revascularization (CABG) in patients with multivessel coronary artery disease (MVD) with or without unprotected left main coronary artery disease (ULMCA) is a treatment of choice. On the other hand due to increased perioperative risk with concomitant non-ST elevation acute coronary syndrome (NSTE-ACS) percutaneous coronary intervention (PCI) is becoming a popular method of revascularization. Therefore the aim of this study is to compare early and late results after PCI and CABG in this population. Methods: A multicenter “all comers” registry included 3797 patients with MVD with or without ULMCA stenosis and NSTE-ACS diagnosed between January 2005 and December 2009. After emergent coronary angiography, 2449 patients underwent PCI whereas 1338 were assigned for CABG. The propensity score analysis was utilized for patients baseline characteristics adjustment. Results: In the crude analysis patients assigned for PCI were younger (64.3 ⫾ 10 vs. 65.2 ⫾ 9 p⫽0.03),more frequently presented with non ST elevation myocardial infarction (NSTEMI) (36.3 vs. 14.9% p⬍0.01) cardiogenic shock (CS) (1.1 vs. 0.1% p⬍0.01) history of prior PCI (7.8 vs. 3.1%; p⬍0.01) and CABG (6.8 vs. 2.1%). The Euroscore was higher in PCI patients (8.2 vs. 6.1 p⬍0.01). On the other hand patients in CABG cohort had more lesions (3.1 vs. 2.4; p⬍0.01) Drug eluting stents were implanted in 7.5% procedures. In unmatched analysis there was a trend toward lower mortality in PCI group at 30 days (2.2 vs. 3.1% p⫽0.1). At one year follow up survival was significantly higher after PCI when compared to CABG (93.6 vs. 90.9%; p⫽0.02). After adjustment, one year survival was comparable between cohorts (92.9% vs. 90.6%; p⫽0.22) and two year survival was significantly higher after PCI (90.9 vs. 83.9%; p⫽0.01). Cardiogenic shock at admission and surgical revascularization were the only independent predictors of long term mortality. Conclusion: In patients with NSTE - ACS and MVD with or without ULMCA stenosis, stenting is at least non inferior alternative to CABG, despite higher clinical risk of PCI cohort. The prospective randomized trial is guaranteed to confirm the results of this hypothesis generating registry

The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Oral