Long-term clinical outcomes after drug-eluting stent implantation in unprotected left main coronary artery disease.
OBJECTIVE
To investigate long-term outcomes of unprotected left main coronary artery (ULMCA) disease treatment using drug-eluting stents (DES).


BACKGROUND
In several studies, DES implantation in ULMCA appeared safe and effective at mid-term; however, to date, there is limited long-term data.


METHODS
All consecutive patients undergoing sirolimus- or paclitaxel-eluting stent implantation in ULMCA disease at a single institution were evaluated. The primary endpoint was long-term major adverse cardiac events (MACE) defined as cardiac death, nonfatal myocardial infarction, or target lesion revascularization (TLR). Stent thrombosis (ST), according to Academic Research Consortium definitions, was also evaluated.


RESULTS
A total of 210 patients were assessed. In-hospital MACE rate was 1%. During a mean follow-up of 28.0 +/- 14.5 months, MACE occurred in 26 patients (12.5%): cardiac death in nine patients (4.3%) and TLR in 17 patients (8.2%). The cumulative MACE-free survival rate was 89.0, 87.4, and 85.4% at 1, 2, and 3 years, respectively. ST occurred in three patients (1.4%): one case was definite and the other two were probable/possible ST; there were no cases of very late ST. Binary restenosis occurred in 8.3%. The EuroScore >6 was the only independent predictor of MACE [hazard ratio (HR) 2.24, 95% confidence interval (CI) 1.05-4.77, P = 0.04]. There was a trend toward an increased risk of MACE associated with distal ULMCA location (HR 2.14, 95% CI 0.87-5.29, P = 0.10).


CONCLUSIONS
Our study showed DES implantation in ULMCA to be feasible, safe, and effective at long term. Randomized trials comparing percutaneous versus surgical revascularization are warranted to define the treatment of choice for ULMCA disease.
Tamburino
Corrado
C
Division of Cardiology, University of Catania, Catania, Italy.
Angiolillo
Dominick J
DJ
Capranzano
Piera
P
Di Salvo
Marilena
M
Ussia
Giampaolo
G
La Manna
Alessio
A
Guzman
Luis A
LA
Galassi
Alfredo R
AR
Bass
Theodore A
TA
D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017239:Paclitaxel / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D012008:Recurrence; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
D017239:Paclitaxel; D020123:Sirolimus