Are drug-eluting stents superior to bare-metal stents in patients with unprotected non-bifurcational left main disease? Insights from a multicentre registry.
OBJECTIVE
To compare long-term clinical outcome following drug-eluting stents (DES) or bare-metal stents (BMS) implantation on lesions located at the ostium or the shaft of the left main in a large real-world population. The advent of DES decreased the risk of unprotected left main coronary artery (ULMCA) restenosis when compared with BMS, but it is unclear if this advantage continues when non-bifurcational lesions are considered.


RESULTS
The GISE-SICI registry is a retrospective, observational multicentre registry promoted by the Italian Society of Invasive Cardiology in which 19 high-volume participating centres enrolled 1453 consecutive patients who underwent percutaneous coronary intervention on ULMCA between January 2002 and December 2006. From the registry, a total of 479 consecutive patients with ostial and shaft lesions who underwent DES (n = 334) or BMS (n = 145) implantation were analysed with extensive multivariable and propensity score adjustments. At 3-year follow-up, risk-adjusted survival rates were higher in patients treated with DES than in those treated with BMS. The adjusted hazard ratio (HR) for the risk of mortality after DES implantation relative to BMS implantation was 0.37 (95% CI: 0.15-0.96, P = 0.04). The adjusted HR for the risk of cardiac mortality was 0.31 (95% CI: 0.09-1.04, P = 0.06). The adjusted 3-year rates of target lesion revascularization (TLR) were not significantly lower in the DES group than in the BMS group (P = 0.60).


CONCLUSIONS
In a large population of patients with lesions located at the ostium or the shaft of the left main in a real-world setting, DES were associated with favourable clinical outcomes when compared with BMS, although there was no evidence of a significant reduction in TLR with DES vs. BMS.
Tamburino
Corrado
C
Dipartimento di Cardiologia, Ospedale Ferrarotto, Università di Catania, via Citelli 6, 95124 Catania, Italy. tambucor@unict.it
Di Salvo
Maria Elena
ME
Capodanno
Davide
D
Marzocchi
Antonio
A
Sheiban
Imad
I
Margheri
Massimo
M
Maresta
Aleardo
A
Barlocco
Fabio
F
Sangiorgi
Giuseppe
G
Piovaccari
Giancarlo
G
Bartorelli
Antonio
A
Briguori
Carlo
C
Ardissino
Diego
D
Di Pede
Francesco
F
Ramondo
Angelo
A
Inglese
Luigi
L
Petronio
Anna Sonia
AS
Bolognese
Leonardo
L
Benassi
Alberto
A
Palmieri
Cataldo
C
Patti
Aldo
A
De Servi
Stefano
S
D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D003331:Coronary Vessels / Q000473:pathology; D054855:Drug-Eluting Stents; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008670:Metals; D008875:Middle Aged; D012042:Registries; D015607:Stents; D016896:Treatment Outcome
D008670:Metals