title: Unprotected left main stenting in the real world: five-year outcomes of the French Left Main Taxus registry.
abstract: OBJECTIVE
  Limited long-term data are available to support drug-eluting stent (DES) unprotected left main (LM) intervention. We sought to evaluate long-term outcomes of LM intervention with paclitaxel-eluting stents.
  
  
  RESULTS
  In this prospective multicentre registry, 291 patients with unprotected LM stenosis underwent percutaneous revascularisation with the TAXUS® Express® stent, using a consistent technical approach for both ostial/shaft and bifurcation lesions (provisional side branch stenting). At five years (n=263), the cumulative incidence of major adverse cardiac events (MACE) and cardiac death were 23.6% and 12.5%, respectively. Myocardial infarction (MI) occurred in 16 patients (6.1%), definite stent thrombosis in 0.4%, and target lesion revascularisation (TLR) was required in 10.3%. Patients with distal LM lesions requiring two-stent procedures had increased MACE compared with those with single-stent interventions (34.1% vs. 17.8%, p=0.009). This was primarily driven by an increased incidence of cardiac death (18.2% vs. 8.5%, p=0.05). Diabetes was associated with increased TLR and was an independent predictor of MACE at five years (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.10-3.99, p=0.02).
  
  
  CONCLUSIONS
  This study confirms the long-term safety and efficacy of the TAXUS® DES in unprotected LM stenting. Diabetes and the need for a second stent in distal LM interventions were associated with an increased risk of adverse outcomes.
authors.affiliation: Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques-Cartier, 6 Avenue du Noyer Lamber, Massy, France. darrenmylotte@gmail.com
authors.forename: Darren
authors.initials: D
authors.lastname: Mylotte
authors.forename: Brahim
authors.initials: B
authors.lastname: Meftout
authors.forename: Anouska
authors.initials: A
authors.lastname: Moynagh
authors.forename: Beatriz
authors.initials: B
authors.lastname: Vaquerizo
authors.forename: Olivier
authors.initials: O
authors.lastname: Darremont
authors.forename: Marc
authors.initials: M
authors.lastname: Silvestri
authors.forename: Yves
authors.initials: Y
authors.lastname: Louvard
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Leymarie
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D023903:Coronary Restenosis / Q000453:epidemiology; D023921:Coronary Stenosis / Q000628:therapy*; D003328:Coronary Thrombosis / Q000453:epidemiology / Q000517:prevention & control; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D017239:Paclitaxel / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel