title: Are paclitaxel-eluting stents better in unprotected left main coronary artery disease? Three-year clinical and intravascular imaging results from a randomized study.
abstract: OBJECTIVE
  Recent publications have demonstrated superior outcomes in unprotected left main patients after paclitaxel-eluting stent (PES) implantation. Long-term data in these patients are limited. The aim of this study was to evaluate if intravascular ultrasound (IVUS)-guided PES implantation is superior to bare metal stent (BMS) implantation in unprotected left main disease after lesion pretreatment with cutting balloon during long-term follow-up.
  
  
  METHODS
  Unprotected left main patients were randomized to BMS (n=50) or PES implantation (n=53). All interventions were IVUS-guided and cutting balloon pretreatment before stenting was performed in all patients. All patients were scheduled for 6-month and 3-year follow-up. Subgroups of patients who underwend IVUS and OCT imaging at 3-year follow-up were analyzed. The primary endpoint was the major adverse cardiac events (MACEs) defined as death, Q-wave myocardial infarction, or target lesion revascularization.
  
  
  RESULTS
  Baseline characteristics were similar in both the groups with a mean SYNTAX score of 31.4±14.5 in BMS and 32.6±11.7 in PES patients (P=0.718). At 3 years, MACEs occurred in 18 patients (36.0%) in the BMS and 7 patients (13.2%) in the PES group (P=0.011). By IVUS, percent neointimal volume obstruction at 3 years was reduced from 18.1%±8.7% with BMSs to 10.0%±5.4% with PESs (P<0.001). The total number of uncovered stent struts per OCT image and IVUS image was 0.4±0.8 and 1.2±1.5, respectively (P<0.001).
  
  
  CONCLUSIONS
  The current study demonstrated that IVUS-guided PES implantation was superior to BMS implantation after cutting balloon pretreatment in unprotected left main disease at 3 years. If compared with IVUS, OCT was more precise in the assessment of stent endothelization.
authors.affiliation: Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia.
authors.forename: Inga
authors.initials: I
authors.lastname: Narbute
authors.forename: Sanda
authors.initials: S
authors.lastname: Jegere
authors.forename: Indulis
authors.initials: I
authors.lastname: Kumsars
authors.forename: Iveta
authors.initials: I
authors.lastname: Mintale
authors.forename: Ilja
authors.initials: I
authors.lastname: Zakke
authors.forename: Kristine
authors.initials: K
authors.lastname: Bumeistere
authors.forename: Dace
authors.initials: D
authors.lastname: Sondore
authors.forename: Alona
authors.initials: A
authors.lastname: Grave
authors.forename: Andrejs
authors.initials: A
authors.lastname: Erglis
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D050257:Tubulin Modulators / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional
chemical_list: D050257:Tubulin Modulators; D017239:Paclitaxel