title: Effectiveness of drug-eluting stent implantation for patients with unprotected left main coronary artery stenosis.
abstract: This study was aimed to evaluate outcomes of patients with unprotected left main coronary artery (LMCA) stenosis who were treated with drug-eluting stents. Sixty-three consecutive patients with unprotected LMCA stenosis were treated with sirolimus-eluting stents in 52 (83%) patients and paclitaxel-eluting stents in 11 (17%) patients, in whom percutaneous intervention was considered the sole alternative because of high surgical risk and/or patient preference. Urgent percutaneous coronary intervention within 24 hours after angiography was performed in 6 (10%) patients. The patients were predominantly at high surgical risk with 35 (56%) having EuroSCORE >6 and 39 (62%) having Parsonnet score >15. Involvement of the distal LMCA was observed in 46 (73%) patients. Procedural success was achieved in all patients. Intravascular ultrasound was used in 51 (81%) patients. Single-stenting strategy was adopted in 36 (78%) patients with bifurcation stenosis. There were no death, Q-wave myocardial infarction, stent thrombosis, or urgent repeat revascularization events during hospitalization. Over a mean follow-up of 11.7 +/- 7.7 months, 18 (29%) patients experienced major adverse cardiac events, including 3 (5%) deaths, 7 (11%) myocardial infarctions, and 10 (16%) target lesion revascularizations. Stent thrombosis developed in 1 (0.6%) patient at 35 days after the procedure. Bifurcation involvement was an independent predictor of major adverse cardiac events by multivariate analysis (hazard ratio 12.90, 95% confidence interval 1.36 to 122.45, p = 0.0259). In conclusion, drug-eluting stent placement for unprotected LMCA stenosis may be a feasible therapeutic alternative in patients at high surgical risk. However, bifurcation stenosis remains a significant predictor of unfavorable clinical outcome.
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York, USA.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Emilia
authors.initials: E
authors.lastname: Solinas
authors.forename: Jiro
authors.initials: J
authors.lastname: Aoki
authors.forename: Helen
authors.initials: H
authors.lastname: Parise
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Theresa
authors.initials: T
authors.lastname: Franklin-Bond
authors.forename: Neil K
authors.initials: NK
authors.lastname: Dasgupta
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Issam
authors.initials: I
authors.lastname: Moussa
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Michael
authors.initials: M
authors.lastname: Collins
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods*; D017239:Paclitaxel / Q000494:pharmacology*; D011446:Prospective Studies; D020123:Sirolimus / Q000494:pharmacology*; D015607:Stents; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000494:pharmacology; D018084:Ultrasonography, Interventional
chemical_list: D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D050257:Tubulin Modulators; D017239:Paclitaxel; D020123:Sirolimus