title: Comparison of 5-year outcomes in patients with and without unprotected left main coronary artery disease after treatment with sirolimus-eluting stents: insights from the j-Cypher registry.
abstract: OBJECTIVE
  This study assessed 5-year outcomes after implantation of sirolimus-eluting stents (SES) for unprotected left main coronary artery (ULMCA) disease in comparison with that for non-left main disease.
  
  
  BACKGROUND
  More information on long-term outcomes after ULMCA stenting is needed.
  
  
  METHODS
  The j-Cypher is a multicenter prospective registry of consecutive patients undergoing SES implantation in Japan.
  
  
  RESULTS
  Among 12,812 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 5 years was significantly higher in patients with ULMCA stenting than in patients without ULMCA stenting (22.8% vs. 14.1%; p < 0.0001); however, the risk for death with ULMCA stenting was no longer significant after adjusting for confounders (hazard ratio: 1.18, 95% confidence interval: 0.95 to 1.46; p = 0.14). In the lesion-level comparison, the nonbifurcation ULMCA lesions treated exclusively with SES had a significantly lower rate of target lesion revascularization (TLR) than those in non-ULMCA nonbifurcation lesions (2.4% vs. 12.7%; p = 0.04). Among bifurcation lesions, those treated with a provisional 2-stent approach had similar rates of TLR (12.1% vs. 11.4%; p = 0.79) between the ULMCA and non-ULMCA groups. Lesions treated with an elective 2-stent approach had higher TLR rates in the ULMCA group as compared with the non-ULMCA group (33.5% vs. 19.7%; p = 0.002).
  
  
  CONCLUSIONS
  The safety of ULMCA stenting relative to non-LMCA stenting was maintained through 5 years follow-up. In terms of efficacy, SES implantation in nonbifurcation ULMCA lesions was associated with an extremely low cumulative incidence of TLR, whereas the elective 2-stent approach for ULMCA bifurcation lesions was associated with a markedly higher cumulative incidence of TLR as compared with that for non-ULMCA bifurcation lesions.
authors.affiliation: Wakayama Medical Center, Wakayama, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Toyofuku
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shiode
authors.forename: Hideo
authors.initials: H
authors.lastname: Nishikawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakao
authors.forename: Kinya
authors.initials: K
authors.lastname: Shirota
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kawai
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nozaki
authors.forename: Takaaki
authors.initials: T
authors.lastname: Isshiki
authors.forename: Takahito
authors.initials: T
authors.lastname: Sone
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D020123:Sirolimus
keywords: CABG; CI; HR; LCX; MI; PCI; SES; ST; TLR; ULMCA; bifurcation; confidence interval; coronary artery bypass grafting; hazard ratio; left circumflex coronary artery; left main disease; myocardial infarction; percutaneous coronary intervention; sirolimus-eluting stent; sirolimus-eluting stent(s); stent thrombosis; target-lesion revascularization; unprotected left main coronary artery