title: Treatment of multivessel coronary artery disease with sirolimus-eluting stent implantation: immediate and mid-term results.
abstract: OBJECTIVE
  This study evaluated clinical outcome after multivessel stenting with sirolimus-eluting stents (SES) in unselected lesions.
  
  
  BACKGROUND
  Safety and effectiveness of multivessel SES implantation is currently unknown.
  
  
  METHODS
  Major adverse cardiac events (MACE) (death, myocardial infarction [MI], and repeat revascularization) were analyzed at 30 days and at 6 months after multivessel SES implantation.
  
  
  RESULTS
  In 155 consecutive patients, 573 SES were implanted in 3.3 +/- 1.3 lesions per patient. At 30 days, the cumulative MACE rate was 10.3%: 7.1% patients developed a non-Q-wave MI, 1.9% developed a Q-wave MI, 0.6% died for non-cardiac reasons, and 0.6% had a repeat revascularization. Clinical follow-up was obtained in all 112 eligible patients treated for 359 lesions at a mean time of 6.5 +/- 2.2 months. The cumulative MACE rate was 22.3%: 3 (2.7%) deaths (1 for cardiac reasons), 4 (3.6%) MIs, target lesion revascularization (TLR) in 16 (14.3%) patients with 24 (6.7%) lesions. Target vessel revascularization was required in 18 (16.1%) patients due to TLR of lesions treated with SES or to disease progression (1.8% of patients). Cox regression analysis revealed total stent length per patient as the most powerful independent predictor of MACE. Overall stent thrombosis occurred in three (1.9%) patients.
  
  
  CONCLUSIONS
  Multivessel SES implantation can be safely performed on patients with complex coronary artery disease. The need for revascularization increases because of the cumulative effect of TLR on patients with multiple lesions.
authors.affiliation: EMO, Centro Cuore Columbus Hospital, Milan, Italy.
authors.forename: Dejan
authors.initials: D
authors.lastname: Orlic
authors.forename: Erminio
authors.initials: E
authors.lastname: Bonizzoni
authors.forename: Goran
authors.initials: G
authors.lastname: Stankovic
authors.forename: Flavio
authors.initials: F
authors.lastname: Airoldi
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Nicola
authors.initials: N
authors.lastname: Corvaja
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: Massimo
authors.initials: M
authors.lastname: Ferraro
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D007527:Isoenzymes / Q000097:blood; D007558:Italy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012086:Reoperation; D020123:Sirolimus / Q000627:therapeutic use*; D015607:Stents; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D020123:Sirolimus