title: Sirolimus-eluting stent treatment for isolated proximal left anterior descending artery stenoses. Results from the prospective multi-center German Cypher Registry.
abstract: BACKGROUND
  Stenting of isolated proximal LAD stenoses is still a controversial issue since it is associated with higher target vessel revascularization (TVR) rate than both bypass surgery using the internal mammary artery, and stenting of other coronary artery territories. The sirolimus- eluting stent (SES) has been reported to significantly reduce restenosis rates in de novo coronary lesions. Therefore, we compared patients from the German Cypher Registry treated with SES for isolated proximal LAD lesions with those stented for isolated lesions in the proximal LCX or RCA.
  
  
  METHODS
  A total of 349 patients treated with SES were analyzed. 249 patients were treated for proximal LAD stenosis, and 100 for proximal LCX/RCA stenoses. The combined clinical endpoint was MACCE (death of any cause, non-fatal MI and non-fatal stroke) and TVR at 6 months.
  
  
  RESULTS
  In-hospital events (death, MI and TVR) did not differ significantly between both groups (3.2% for the LAD group vs 2.0% for the LCX/RCA-group, p=0.73). The combined end point of death of any cause, non-fatal MI and non-fatal stroke at six months was 2.6% in the LAD group, and 2.2% in the LCX/RCA group (p=1.0). TVR occurred in 4.8% of the LAD group and in 6.5% of the LCX/RCA group at six months (p=0.58). The percentage of patients free from angina at daily activities was 80.6% in the LAD group, and 77.4% in the LCX/ RCA group (p=0.52).
  
  
  CONCLUSIONS
  SES once implanted into isolated proximal LAD stenoses appears as effective as reported in other vessel territories. Accordingly, stenting of the proximal LAD using SES might prove a suitable alternative to surgery.
authors.affiliation: Herzzentrum Segeberger Kliniken GmbH, Am Kurpark 1, 23795 Bad Segeberg, Germany. ahmed.khattab@segebergerkliniken.de
authors.forename: A A
authors.initials: AA
authors.lastname: Khattab
authors.forename: C W
authors.initials: CW
authors.lastname: Hamm
authors.forename: J
authors.initials: J
authors.lastname: Senges
authors.forename: R
authors.initials: R
authors.lastname: Toelg
authors.forename: V
authors.initials: V
authors.lastname: Geist
authors.forename: T
authors.initials: T
authors.lastname: Bonzel
authors.forename: M
authors.initials: M
authors.lastname: Kelm
authors.forename: B
authors.initials: B
authors.lastname: Levenson
authors.forename: C A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: G
authors.initials: G
authors.lastname: Sabin
authors.forename: S
authors.initials: S
authors.lastname: Schneider
authors.forename: U
authors.initials: U
authors.lastname: Tebbe
authors.forename: G
authors.initials: G
authors.lastname: Richardt
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000287:Administration, Topical; D000368:Aged; D002423:Cause of Death; D020099:Coated Materials, Biocompatible; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D020766:Intracranial Embolism / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D011859:Radiography; D012042:Registries / Q000706:statistics & numerical data; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D020123:Sirolimus