Favorable long-term outcome after drug-eluting stent implantation in nonbifurcation lesions that involve unprotected left main coronary artery: a multicenter registry.
BACKGROUND
The presence of a lumen narrowing at the ostium and the body of an unprotected left main coronary artery but does not require bifurcation treatment is a class I indication of surgical revascularization.


RESULTS
A total of 147 consecutive patients who had a stenosis in the ostium and/or the midshaft of an unprotected left main coronary artery (treatment of the bifurcation not required) and were electively treated with percutaneous coronary intervention and sirolimus-eluting stents (n=107) or paclitaxel-eluting stents (n=40) in 5 centres were included in this registry. In 72 patients (almost 50%), intravascular ultrasound guidance was performed. Procedural success was achieved in 99% of the patients; in 1 patient with stenosis in the left main coronary artery ostium, a >30% residual stenosis persisted at the end of the procedure, and the patient was referred for coronary artery bypass graft surgery. During hospitalization, no patients experienced a Q-wave myocardial infarction or died. One patient died 19 days after the procedure because of pulmonary infection. At long-term clinical follow-up (886+/-308 days), 5 patients had died; 7 patients had target vessel revascularization (5 repeat percutaneous coronary interventions and 2 coronary artery bypass graft surgeries), and of these only 1 patient had a target lesion revascularization. Angiographic follow-up was performed in 106 patients (72%) with a late loss of -0.01 mm. Restenosis in the left main trunk occurred only in 1 patient (0.9%).


CONCLUSIONS
Percutaneous coronary intervention with sirolimus-eluting stents or paclitaxel-eluting stents implantation in nonbifurcation left main coronary artery lesions appears safe with a long-term major adverse clinical event rate of 7.4% and a restenosis rate of 0.9%.
Chieffo
Alaide
A
San Raffaele Scientific Institute and Emo Centro Cuore Columbus, Via Olgettina 60, 20132 Milan, Italy.
Park
Seung J
SJ
Valgimigli
Marco
M
Kim
Young H
YH
Daemen
Joost
J
Sheiban
Imad
I
Truffa
Alessandra
A
Montorfano
Matteo
M
Airoldi
Flavio
F
Sangiorgi
Giuseppe
G
Carlino
Mauro
M
Michev
Iassen
I
Lee
Cheol W
CW
Hong
Myeong K
MK
Park
Seong W
SW
Moretti
Claudio
C
Bonizzoni
Erminio
E
Rogacka
Renata
R
Serruys
Patrick W
PW
Colombo
Antonio
A
D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012449:Safety; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology