Early and long-term results of unprotected left main coronary artery stenting: the LE MANS (Left Main Coronary Artery Stenting) registry.
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.
Buszman
Pawel E
PE
Medical University of Silesia, Katowice, Ziolowa 45/47 Street, Poland. pbuszman@ka.onet.pl
Buszman
Piotr P
PP
Kiesz
R Stefan
RS
Bochenek
Andrzej
A
Trela
Blazej
B
Konkolewska
Magda
M
Wallace-Bradley
David
D
Wilczyński
Mirosław
M
Banasiewicz-Szkróbka
Iwona
I
Peszek-Przybyla
Ewa
E
Krol
Marek
M
Kondys
Marek
M
Milewski
Krzysztof
K
Wiernek
Szymon
S
Debiński
Marcin
M
Zurakowski
Aleksander
A
Martin
Jack L
JL
Tendera
Michał
M
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