title: Long-term safety and effectiveness of unprotected left main coronary stenting with drug-eluting stents compared with bare-metal stents.
abstract: BACKGROUND
  Limited information is available on long-term outcomes for patients with unprotected left main coronary artery disease who received drug-eluting stents (DES).
  
  
  RESULTS
  In the multicenter registry evaluating outcomes among patients with unprotected left main coronary artery stenosis undergoing stenting with either bare metal stents (BMS) or DES, 1217 consecutive patients were divided into 2 groups: 353 who received only BMS and 864 who received at least 1 DES. The 3-year outcomes were compared by use of the adjustment of inverse-probability-of-treatment-weighted method. Patients receiving DES were older and had a higher prevalence of diabetes mellitus, hypertension, hyperlipidemia, and multivessel disease. In the overall population, with the use of DES, the 3-year adjusted risk of death (8.0% versus 9.5%; hazard ratio, 0.71; 95% confidence interval, 0.36 to 1.40; P=0.976) or death or myocardial infarction (14.3% versus 14.9%; hazard ratio, 0.83; 95% confidence interval, 0.49 to 1.40; P=0.479) was similar compared with BMS. However, the risk of target lesion revascularization was significantly lower with the use of DES than BMS (5.4% versus 12.1%; hazard ratio, 0.40; 95% confidence interval, 0.22 to 0.73; P=0.003). When patients were classified according to lesion location, DES was still associated with lower risk of target lesion revascularization in patients with bifurcation (6.9% versus 16.3%; hazard ratio, 0.38; 95% confidence interval, 0.18 to 0.78; P=0.009) or nonbifurcation (3.4% versus 10.3%; hazard ratio, 0.39; 95% confidence interval, 0.17 to 0.88; P=0.024) lesions with a comparable risk of death or myocardial infarction.
  
  
  CONCLUSIONS
  Compared with BMS, DES was associated with a reduction in the need for repeat revascularization without increasing the risk of death or myocardial infarction for patients with unprotected left main coronary artery stenosis.
authors.affiliation: Asan Medical Center, Seoul, South Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
authors.forename: Myung-Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: In-Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Hun Sik
authors.initials: HS
authors.lastname: Park
authors.forename: Taehoon
authors.initials: T
authors.lastname: Ahn
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Chae
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
authors.forename: Wook-Sung
authors.initials: WS
authors.lastname: Chung
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D023903:Coronary Restenosis / Q000401:mortality*; D023921:Coronary Stenosis / Q000401:mortality* / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D012449:Safety; D055502:Secondary Prevention
chemical_list: D008670:Metals