Sirolimus- vs. paclitaxel-eluting stents for the treatment of unprotected left main coronary artery stenosis: complete 2-year follow-up of a two-center registry.
BACKGROUND
The feasibility of percutaneous coronary intervention (PCI) using drug-eluting stents and its comparability with bypass surgery in treatment of unprotected left main coronary artery (LMCA) stenosis has been shown previously. We compared the mid-to long-term outcome between sirolimus-(SES) vs. paclitaxel-eluting stents (PES) in an all-comer analysis that included all patients with unprotected LMCA stenosis who underwent PCI with SES or PES.


METHODS
From March 2003 and June 2007, 196 patients underwent PCI with SES or PES for unprotected LMCA stenosis at Seoul National University Main or Bundang Hospital; SES was implanted in 141 patients and PES in 55 patients. The baseline clinical and procedural characteristics were mostly similar between the SES and PES group.


RESULTS
After 2 years of follow-up, there were no differences in the rate of cardiac death (9.1% vs. 8.5%) and nonfatal MI (5.5% vs. 2.8%) between the two groups. However, the risk of repeat revascularization tended to be lower in the SES group compared with the PES group [TLR, 9.9% vs. 20.0% (P=0.06); TVR, 17.7% vs. 30.9% (P=0.05)], which did not reach statistical significance. The rate of stent thrombosis (ST) was also similar between the two groups (3.6% vs. 2.1% for definite ST, 3.6% vs. 2.8% for definite+probable ST).


CONCLUSIONS
In all-comers undergoing first generation DES implantation for unprotected LMCA stenosis, PES and SES showed comparable 2-year clinical results regarding hard endpoints and major adverse cardiac events.
Park
Kyung Woo
KW
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
Kang
Si-Hyuck
SH
Park
Keun-Ho
KH
Choi
Dong-Hyun
DH
Lee
Hae-Young
HY
Kang
Hyun-Jae
HJ
Cho
Young-Seok
YS
Yeon
Tae-Jin
TJ
Chung
Woo-Young
WY
Koo
Bon-Kwon
BK
Chae
In-Ho
IH
Choi
Dong-Ju
DJ
Oh
Byung-Hee
BH
Park
Young-Bae
YB
Kim
Hyo-Soo
HS
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D023921:Coronary Stenosis / Q000401:mortality* / Q000628:therapy*; D003328:Coronary Thrombosis / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use*
D000972:Antineoplastic Agents, Phytogenic; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus