title: Everolimus-eluting stent implantation for unprotected left main coronary artery stenosis. The PRECOMBAT-2 (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) study.
abstract: OBJECTIVE
  This study sought to evaluate the safety and efficacy of second-generation drug-eluting stents (DES) for patients with unprotected left main coronary artery (ULMCA) stenosis.
  
  
  BACKGROUND
  The clinical benefit of second-generation DES for ULMCA stenosis has not been determined.
  
  
  METHODS
  The authors assessed 334 consecutive patients who received everolimus-eluting stents (EES) for ULMCA stenosis between 2009 and 2010. The 18-month incidence rates of major adverse cardiac or cerebrovascular events (MACCE), including death, myocardial infarction (MI), stroke, or ischemia-driven target vessel revascularization (TVR), were compared with those of a randomized study comparing patients who received sirolimus-eluting stents (SES) (n = 327) or coronary artery bypass grafts (CABG) (n = 272).
  
  
  RESULTS
  EES (8.9%) showed a comparable incidence of MACCE as SES (10.8%; adjusted hazard ratio [aHR] of EES: 0.84; 95% confidence interval [CI]: 0.51 to 1.40; p = 0.51) and CABG (6.7%, aHR of EES: 1.40; 95% CI: 0.78 to 2.54; p = 0.26). The composite incidence of death, MI, or stroke also did not differ among patients receiving EES (3.3%), SES (3.7%; aHR of EES: 0.63; 95% CI: 0.27 to 1.47; p = 0.29), and CABG (4.8%; aHR of EES: 0.67; 95% CI: 0.29 to 1.54; p = 0.34). However, the incidence of ischemia-driven TVR in the EES group (6.5%) was higher than in the CABG group (2.6%, aHR of EES: 2.77; 95% CI: 1.17 to 6.58; p = 0.02), but comparable to SES (8.2%, aHR of EES: 1.14; 95% CI: 0.64 to 2.06; p = 0.65). Angiographic restenosis rates were similar in the SES and EES groups (13.8% vs. 9.2%, p = 0.16).
  
  
  CONCLUSIONS
  Second-generation EES had a similar 18-month risk of MACCE for ULMCA stenosis as first-generation SES or CABG.
authors: University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Young-Hak
authors: YH
authors: Kim
authors: Duk-Woo
authors: DW
authors: Park
authors: Jung-Min
authors: JM
authors: Ahn
authors: Sung-Cheol
authors: SC
authors: Yun
authors: Hae Geun
authors: HG
authors: Song
authors: Jong-Young
authors: JY
authors: Lee
authors: Won-Jang
authors: WJ
authors: Kim
authors: Soo-Jin
authors: SJ
authors: Kang
authors: Seung-Whan
authors: SW
authors: Lee
authors: Cheol Whan
authors: CW
authors: Lee
authors: Seong-Wook
authors: SW
authors: Park
authors: Yangsoo
authors: Y
authors: Jang
authors: Myung-Ho
authors: MH
authors: Jeong
authors: Hyo-Soo
authors: HS
authors: Kim
authors: Seung-Ho
authors: SH
authors: Hur
authors: Seung-Woon
authors: SW
authors: Rha
authors: Do-Sun
authors: DS
authors: Lim
authors: Sung-Ho
authors: SH
authors: Her
authors: Ki Bae
authors: KB
authors: Seung
authors: In-Whan
authors: IW
authors: Seong
authors: Seung-Jung
authors: SJ
authors: Park
mesh_terms: D016001:Confidence Intervals; D001026:Coronary Artery Bypass; D023903:Coronary Restenosis / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012306:Risk; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus