title: Clinical outcome after management of unprotected left main in-stent restenosis after bare metal or drug-eluting stents.
abstract: BACKGROUND
  Implantation of either bare metal stent (BMS) or drug-eluting stent (DES) has been used in every day practice for patients with unprotected left main stenosis (UPLMS). There are still a lack of data regarding the subsequent results of UPLMS in-stent restenosis (ISR). The present study aimed at determining the clinical outcome of UPLMS ISR patients after implantation of either BMS or DES.
  
  
  METHODS
  Patients with UPLMS ISR after stenting were included. The primary endpoint was the cumulative major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR).
  
  
  RESULTS
  UPLMS ISR rate was 14.8% (n = 73, 15.7% after BMS, 14.5% for DES) after average of (3.89 +/- 2.01) years (range from 1 to 10.5 years) follow-up. Angiographic follow-up between 6 - 8 months was available in 85.3%. Of these, repeat percutaneous coronary intervention (PCI) was used in 62 (84.9%) patients, with medicine only in 9 (12.4%) and coronary artery bypass graft (CABG) in 2 (2.7%). Most repeat PCI patients were with unstable angina (87.0%), and had decreased left ventricular ejection fraction ((42.58 +/- 5.12)%), fewer focal/ostial left circumflex branch (LCX) lesions, in relative to medicine only group. After (31.9 +/- 23.3) months, the MACE, MI, TVR and cardiac death were 31.5%, 1.4%, 24.1% and 8.2%, respectively. Definite and possible stent thrombosis occurred in 1 (1.4%) patient.
  
  
  CONCLUSIONS
  Medical therapy for asymptomatic isolated ostial LCX was safe. Repeat PCI for UPLMS ISR was associated with acceptable early and short-term clinical outcome. Further study was needed to elucidate the role of CABG in treating UPLMS ISR.
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China. chmengx@126.com
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.forename: Gary
authors.initials: G
authors.lastname: Mintz
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Jing
authors.initials: J
authors.lastname: Kan
authors.forename: Xue-Wen
authors.initials: XW
authors.lastname: Sun
authors.forename: Ai-Ping
authors.initials: AP
authors.lastname: Zhang
authors.forename: Jin-Guo
authors.initials: JG
authors.lastname: Chen
authors.forename: Jun
authors.initials: J
authors.lastname: Qian
authors.forename: Tak W
authors.initials: TW
authors.lastname: Kwan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000473:pathology / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome