Unprotected left main stenting in the real world: two-year outcomes of the French left main taxus registry.
BACKGROUND
Cardiac surgery is the reference treatment for patients with left main (LM) disease, although percutaneous coronary intervention with drug-eluting stents is emerging as a possible alternative. The objective of this registry was to evaluate the 2-year outcome of elective percutaneous coronary intervention for unprotected LM disease with paclitaxel-eluting stents.


RESULTS
A total of 291 patients were prospectively included from 4 centers. Acute myocardial infarction and cardiogenic shock were the only exclusion criteria. Patients were 69+/-11 years old, 29% were diabetic, and 25% had 3-vessel disease. For distal LM lesions (78%), the provisional side-branch T-stenting approach was used in 92% of cases and final kissing balloon inflation in 97%. Angiographic success was obtained in 99.7% of cases. At 2-year follow-up, the total cardiac death rate was 5.4% (1 EuroSCORE point was associated with a 15% [95% confidence interval 2.9% to 28.2%, P=0.013] higher risk of cardiac death), target-lesion revascularization was 8.7%, and incidence of Q-wave or non-Q-wave myocardial infarction was 0.9% and 3.1%, respectively. The combined end point occurred in 15.8% of cases and stroke in 0.7%. The incidence of definite and probable LM stent thrombosis was 0.7%, whereas the incidence of any stent thrombosis was 3.8%, with a higher risk in patients with side-branch stenting in the presence of LM bifurcation lesions (hazard ratio 9.6, 95% confidence interval 1.2 to 77.7, P=0.035).


CONCLUSIONS
Unprotected LM stenting with paclitaxel-eluting stents, with a strategy of provisional side-branch T-stenting for distal lesions, provides excellent acute angiographic results and good mid-term clinical outcomes, with a 15.8% rate of major adverse cardiac events at 2-year follow-up.
Vaquerizo
Beatriz
B
Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France.
Lefèvre
Thierry
T
Darremont
Olivier
O
Silvestri
Marc
M
Louvard
Yves
Y
Leymarie
Jean Louis
JL
Garot
Philippe
P
Routledge
Helen
H
de Marco
Federico
F
Unterseeh
Thierry
T
Zwahlen
Marcel
M
Morice
Marie-Claude
MC
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D011446:Prospective Studies; D012042:Registries; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome
D017239:Paclitaxel