title: Very long-term outcomes following drug-eluting stent implantation for unprotected left main coronary artery stenosis: a single center experience.
abstract: OBJECTIVE
  Encouraging results at long-term follow-up have been reported from non-randomized registries and randomized trials following percutaneous coronary intervention with drug-eluting stent implantation for unprotected left main stenosis. However, information on very long-term (>5-year) outcomes is limited. The aim of this study was to assess the very long-term outcomes (6-years) following drug-eluting stent implantation for left main disease.
  
  
  METHODS
  All consecutive patients with unprotected left main stenosis electively treated with drug-eluting stent implantation, between March 2002 and May 2005, were analyzed according to the location of the left main lesion (distal bifurcation vs ostial/body).
  
  
  RESULTS
  The study included 149 patients: 113 with distal bifurcation and 36 with ostial/body lesion. Triple-vessel disease was significantly higher in the distal than in the ostial/body group (52.2% vs 33.2%, P=.05). At 6-years of follow-up, the cumulative major adverse cardiovascular event rate was 41.6% (45.1% distal vs 30.6% ostial/body, P=0.1), including 18.8% any death (22.1% distal vs 8.3% ostial/body, P=.08), 3.4% myocardial infarction (3.5% distal vs 2.8% ostial/body, P=1), and 15.4% target lesion revascularization (18.6% distal vs 5.6% ostial/body, P=.06). The composite of cardiac death and myocardial infarction was 10.7% (13.3% distal vs 2.8% ostial/body, P=.1) while the definite/probable stent thrombosis rate was 1.4% (all in the distal group).
  
  
  CONCLUSIONS
  At 6-year clinical follow-up, percutaneous coronary intervention with drug-eluting stent implantation for unprotected left main disease was associated with acceptable rates of cardiac death, myocardial infarction and stent thrombosis. Favorable long-term outcomes in ostial/body lesions compared to distal bifurcation lesions were confirmed at long-term clinical follow-up.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milán, Italia.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ielasi
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.forename: Marco
authors.initials: M
authors.lastname: Mussardo
authors.forename: Giedrius
authors.initials: G
authors.lastname: Davidavicius
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D015331:Cohort Studies; D023903:Coronary Restenosis; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D053208:Kaplan-Meier Estimate; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome