title: Early and long-term results of unprotected left main coronary artery stenting: the LE MANS (Left Main Coronary Artery Stenting) registry.
abstract: OBJECTIVE
  The aim of the study was to evaluate early and late outcomes after percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCA) and to compare bare-metal stent (BMS) and drug-eluting stent (DES) subgroups.
  
  
  BACKGROUND
  PCI is an increasingly utilized method of revascularization in patients with ULMCA.
  
  
  METHODS
  This multicenter prospective registry included 252 patients after ULMCA stenting enrolled between March 1997 and February 2008. Non-ST-segment elevation acute coronary syndrome was diagnosed in 58% of patients; ST-segment elevation myocardial infarction cases were excluded. Drug-eluting stents were implanted in 36.2% of patients.
  
  
  RESULTS
  Major adverse cardiovascular and cerebral events (MACCE) occurred in 12 (4.8%) patients during the 30-day period, which included 4 (1.5%) deaths. After 12 months there were 17 (12.1%) angiographically confirmed cases of restenosis. During long-term follow-up (1 to 11 years, mean 3.8 years) there were 64 (25.4%) MACCE and 35 (13.9%) deaths. The 5- and 10-year survival rates were 78.1% and 68.9%, respectively. Despite differences in demographical and clinical data in favor of BMS patients, unmatched analysis showed a significantly lower MACCE rate in DES patients (25.9% vs. 14.9%, p = 0.039). This difference was strengthened after propensity score matching. The DES lowered both mortality and MACCE for distal ULMCA lesions when compared with BMS. Ejection fraction <50% was the only independent risk factor influencing long-term survival.
  
  
  CONCLUSIONS
  Stenting of ULMCA is feasible and offers good long-term outcome. Implantation of DES for ULMCA decreased the risk of long-term MACCE, and particularly improved survival in patients with distal ULMCA disease.
authors.affiliation: Medical University of Silesia, Katowice, Ziolowa 45/47 Street, Poland. pbuszman@ka.onet.pl
authors.forename: Pawel E
authors.initials: PE
authors.lastname: Buszman
authors.forename: Piotr P
authors.initials: PP
authors.lastname: Buszman
authors.forename: R Stefan
authors.initials: RS
authors.lastname: Kiesz
authors.forename: Andrzej
authors.initials: A
authors.lastname: Bochenek
authors.forename: Blazej
authors.initials: B
authors.lastname: Trela
authors.forename: Magda
authors.initials: M
authors.lastname: Konkolewska
authors.forename: David
authors.initials: D
authors.lastname: Wallace-Bradley
authors.forename: Mirosław
authors.initials: M
authors.lastname: Wilczyński
authors.forename: Iwona
authors.initials: I
authors.lastname: Banasiewicz-Szkróbka
authors.forename: Ewa
authors.initials: E
authors.lastname: Peszek-Przybyla
authors.forename: Marek
authors.initials: M
authors.lastname: Krol
authors.forename: Marek
authors.initials: M
authors.lastname: Kondys
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Milewski
authors.forename: Szymon
authors.initials: S
authors.lastname: Wiernek
authors.forename: Marcin
authors.initials: M
authors.lastname: Debiński
authors.forename: Aleksander
authors.initials: A
authors.lastname: Zurakowski
authors.forename: Jack L
authors.initials: JL
authors.lastname: Martin
authors.forename: Michał
authors.initials: M
authors.lastname: Tendera
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011044:Poland / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome