title: [Drug-eluting stents in patients with left main coronary lesions who are not candidates for surgical revascularization].
abstract: OBJECTIVE
  Surgical revascularization is the treatment of choice in patients with left main coronary artery stenosis. Conventional stents are not a valid alternative because of the rate of restenosis and sudden cardiac death. Drug-eluting stents, which reduce the rate of restenosis, may represent an alternative to cardiac surgery. The objective of this study was to describe the results with drug-eluting stents in patients with left main coronary artery stenosis who were poor candidates for surgical revascularization.
  
  
  METHODS
  We prospectively followed a consecutive series of patients who were poor candidates for surgical revascularization and were treated with implantation of a drug-eluting stent in the left main coronary artery between May 2002 and April 2004. In-hospital and long-term results were analyzed. Follow-up included angiographic and intravascular ultrasound (IVUS) studies.
  
  
  RESULTS
  Forty-two patients (25 men, 59.5%) with a mean age of 70.1 (10.5) years were studied. Fourteen (33%) had diabetes, and 7 (16.7%) had a protected left main coronary artery. The reasons for ruling out surgery were poor distal vessels in 19 (45.2%), previous surgery in 9 (21.4%), age in 6 (14.3%), primary angioplasty in 5 (11.4%), and other reasons in 3 (7.2%). Four patients (9.5%) died before discharge, three of them after primary angioplasty. No in-hospital revascularization procedures were needed. Median follow-up time was 288 days; mean follow-up time was 315 (241) days. Another four patients died after discharge (9.5%) on days 5, 24, 34 and 115. Angioplasty was repeated in one patient, and another was referred for heart transplantation.
  
  
  CONCLUSIONS
  Drug-eluting stents represent a valid alternative in patients with left main coronary artery stenosis who are poor candidates for surgical revascularization. Randomized studies with a longer follow-up should be performed to evaluate their benefits in patients eligible for surgery.
authors.affiliation: Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España. imlml9@hotmail.com
authors.forename: Iñigo
authors.initials: I
authors.lastname: Lozano
authors.forename: Claudia
authors.initials: C
authors.lastname: Herrera
authors.forename: César
authors.initials: C
authors.lastname: Morís
authors.forename: Joan A
authors.initials: JA
authors.lastname: Gómez-Hospital
authors.forename: Juan
authors.initials: J
authors.lastname: Rondán
authors.forename: Emili
authors.initials: E
authors.lastname: Iráculis
authors.forename: María
authors.initials: M
authors.lastname: Martín
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.forename: Emma
authors.initials: E
authors.lastname: Suárez
authors.forename: Enrique
authors.initials: E
authors.lastname: Esplugas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents