title: Comparison of drug-eluting stent with bare metal stent for distal de novo unprotected left main coronary artery stenosis. A propensity score-matched cohort study.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) with stent implantation is now considered a safe and feasible treatment for stenosis of the unprotected left main coronary artery (ULMCA). Because few studies have focused on de novo distal ULMCA lesions, a propensity score-matched cohort study was conducted to compare bare metal stents (BMS) with drug-eluting stents (DES) for long-term outcomes following PCI.
  
  
  RESULTS
  This study reviewed the outcomes of patients undergoing PCI with DES (n=127) or BMS (n=51) for distal de novo ULMCA stenosis. The baseline demographic, angiographic and procedural characteristics differed between the 2 groups, indicating potential selection bias. The propensity score-matched cohort showed that the DES group had significantly less target lesion revascularization (TLR) and major adverse cardiovascular events (MACE) following PCI than the BMS group. Furthermore, heart failure (HF) of New York heart Association functional class III/IV was associated with an increased risk of TLR and MACE, whereas implantation of DES in patients with significant HF led to more favorable outcomes.
  
  
  CONCLUSIONS
  Lower rates of TLR and MACE occurred in patients following PCI with DES implantation than with BMS implantation for distal ULMCA stenosis. Implantation of DES in patients with significant HF may improve the unfavorable outcome. When PCI is chosen to manage distal ULMCA stenosis, DES is the preferred stent type.
authors.affiliation: Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
authors.forename: Shu-Kai
authors.initials: SK
authors.lastname: Hsueh
authors.forename: Chiung-Jen
authors.initials: CJ
authors.lastname: Wu
authors.forename: Hsiu-Yu
authors.initials: HY
authors.lastname: Fang
authors.forename: Yuan-Kai
authors.initials: YK
authors.lastname: Hsieh
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fang
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Chen
authors.forename: Shyh-Ming
authors.initials: SM
authors.lastname: Chen
authors.forename: Cheng-Hsu
authors.initials: CH
authors.lastname: Yang
authors.forename: Hon-Kan
authors.initials: HK
authors.lastname: Yip
authors.forename: Mien-Cheng
authors.initials: MC
authors.lastname: Chen
authors.forename: Morgan
authors.initials: M
authors.lastname: Fu
authors.forename: Cheng-I
authors.initials: CI
authors.lastname: Cheng
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D015331:Cohort Studies; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control; D023921:Coronary Stenosis / Q000453:epidemiology / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000517:prevention & control; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D016016:Proportional Hazards Models; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D015983:Selection Bias; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome