title: Long-term follow-up (four years) of unprotected left main coronary artery disease treated with paclitaxel-eluting stents (from the TRUE Registry).
abstract: Limited data are available on the long-term outcome following PCI with paclitaxel-eluting stent (PES) implantation in patients with unprotected left main coronary artery (LMCA). The objective of this study was to evaluate "real world" long-term outcome following paclitaxel-eluting stent (PES) implantation for unprotected LMCA disease in patients enrolled in the TRUE registry.
  
  
  
  From March 2003 to October 2004, 93 consecutive patients (81.7% male) underwent PCI for unprotected LMCA disease. Surveillance angiography was performed at 6.8+/-3.3 months follow-up. The target lesion involved the distal LMCA in 68 (73.1%) patients. Double stenting techniques were performed in 46 (67.6%) distal LMCA, of these 50% were stented using the Crush technique. Clinical follow-up was complete in all patients with 85.8% angiographic follow-up rate. In-segment restenosis occurred in 16 (20.3%) patients and was focal in 72.4% of cases and significantly higher in patients with distal LMCA (36.8% vs. 13.6%, p<0.04). At a median follow-up of 1,450 days (IQR 1281-1595), the overall incidence of MACE was 35.5% and the TLR rate was 25.8% and significantly higher in patients with bifurcation stenting (32.3% vs. 8%, p<0.02). The estimated cardiac survival rate at one and four years was 96.7% and 93.3%, respectively. Total mortality rate was 14.1% and cardiac was 6.5%. There was one (1.1%) definite stent thrombosis (ST) and one (1.1%) probable ST.
  
  
  
  Treatment of unprotected LMCA disease with PES, after four years follow-up, appears to be safe and effective with a low rate of cardiac mortality and overall risk of ST. The need for target lesion revascularisation in 25.8% of patients highlights the need for more effective PCI especially in patients with distal LMCA disease.
authors.affiliation: San Raffaele Institute, Milan, Italy. cosmogodino@gmail.com <cosmogodino@gmail.com>
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Furuichi
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Rossella
authors.initials: R
authors.lastname: Barbagallo
authors.forename: Omer
authors.initials: O
authors.lastname: Goktekin
authors.forename: Michela
authors.initials: M
authors.lastname: Cera
authors.forename: Ralf
authors.initials: R
authors.lastname: Mueller
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.forename: Bernard
authors.initials: B
authors.lastname: Reimers
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Sangiorgi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D017239:Paclitaxel / Q000008:administration & dosage*; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D017239:Paclitaxel