title: New-generation drug-eluting stent experience in the percutaneous treatment of unprotected left main coronary artery disease: the NEST registry.
abstract: OBJECTIVE
  To explore the 2-year clinical outcomes in patients with unprotected left main coronary artery (ULMCA) disease treated with overall new drug-eluting stent (DES) options.
  
  
  BACKGROUND
  Recent available data have shown the feasibility and the safety of new DESs, mainly evaluating the everolimus-eluting stents in the setting of ULMCA disease.
  
  
  METHODS
  Patients with ULMCA disease undergoing percutaneous coronary intervention (PCI) with everolimus-, zotarolimus-, and biolimus A9-eluting stents were prospectively evaluated. The study objective was the composite of major adverse cardiac events (MACEs), consisting of all-cause mortality, myocardial infarction (MI), and target vessel revascularization (TVR) at 2-year clinical follow-up.
  
  
  RESULTS
  A total of 154 patients were analyzed. The mean EuroSCORE and SYNTAX scores were 4.7 ± 2.6 and 27.5 ± 8.3, respectively. Distal location was present in 126 patients (81.8%) and 96 lesions (76.3%) were true Medina bifurcations. The 2-stent technique was used in 73 cases (57.9%). Everolimus-, zotarolimus-, and biolimus A9-eluting stents were implanted in 68 patients (44.2%), 46 patients (29.9%), and 40 patients (25.9%), respectively. At a median clinical follow-up of 551.5 days (interquartile range, 360.8-1045.5 days), MACEs occurred in 29 patients (18.8%). Ten patients (6.5%) died, and 2 deaths (1.3%) were adjudicated as cardiac. No patient had myocardial infarction or definite stent thrombosis (ST). One probable and 1 possible ST were adjudicated. TVR was required in 19 patients (12.3%) and target lesion revascularization was required in only 7 patients (4.5%).
  
  
  CONCLUSIONS
  In our experience, despite the presence of complex distal left main lesions, new DESs in ULMCA disease appear to be promising in terms of safety and efficacy at 2-year clinical follow-up.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Hospital, Via Olgettina 60 20132 Milan, Italy. chiarabernelli@yahoo.it
authors.forename: Chiara
authors.initials: C
authors.lastname: Bernelli
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Gill Louise
authors.initials: GL
authors.lastname: Buchanan
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.forename: Davide
authors.initials: D
authors.lastname: Maccagni
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000639:trends*; D000068338:Everolimus; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013927:Thrombosis / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000068338:Everolimus; C489443:zotarolimus; C518022:umirolimus; D020123:Sirolimus