Early and mid-term results of drug-eluting stent implantation in unprotected left main.
BACKGROUND
The safety and efficacy of percutaneous coronary intervention in unprotected left main (ULM) coronary arteries are still a matter of debate.


RESULTS
All consecutive patients who had a sirolimus-eluting stent (Cypher, Cordis, Johnson and Johnson Co) or a paclitaxel-eluting stent (Taxus, Boston Scientific) electively implanted in de novo lesions on unprotected left main were analyzed. Patients treated with a drug-eluting stent (DES) were compared with the historical group of consecutive patients treated with bare metal stent (BMS). Eighty-five patients were treated with DES; 64 had BMS implantation. Patients treated with DES had lower ejection fractions (51.1+/-11% versus 57.4+/-13%, P=0.002) and were more often diabetics (21.2% versus 10.9%, P=0.12) with more frequent distal left main involvement (81.2% versus 57.8%, P=0.003). Furthermore, in the DES group, smaller vessels (3.33+/-0.6 versus 3.7+/-0.7 mm, respectively; P=0.0001) with more lesions (2.94+/-1.6 versus 2.25+/-1.3, P=0.004) and vessels (2.03+/-0.69 versus 1.8+/-0.72, P=0.05) were treated with longer stents (24.3+/-12 versus 15.8+/-8.6 mm, P=0.0001). Despite the higher-risk patients and lesion profiles in the DES group, the incidence of major cardiac events at a 6-month clinical follow-up was lower in the DES than in the BMS group (20.0% versus 35.9%, respectively; P=0.039). Moreover, cardiac deaths occurred in 3 DES patients (3.5%), as compared with 6 (9.3%) in the BMS group (P=0.17).


CONCLUSIONS
In this early experience with DES in unprotected left main, this procedure appears safe with favorable and improved clinical results as compared with historical control subjects with a BMS. A randomized study comparing surgery appears justified at present.
Chieffo
Alaide
A
San Raffaele Hospital, Milan, Italy.
Stankovic
Goran
G
Bonizzoni
Erminio
E
Tsagalou
Eleftheria
E
Iakovou
Ioannis
I
Montorfano
Matteo
M
Airoldi
Flavio
F
Michev
Iassen
I
Sangiorgi
Massimo Giuseppe
MG
Carlino
Mauro
M
Vitrella
Giancarlo
G
Colombo
Antonio
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000639:trends*; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D017239:Paclitaxel; D012307:Risk Factors; D020123:Sirolimus; D015607:Stents; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus