title: Long-term clinical outcomes after sirolimus-eluting stent implantation for unprotected left main coronary artery disease.
abstract: Previous studies reporting long-term (≥5 year) clinical outcome in patients with unprotected left main coronary artery (LMCA) disease undergoing drug-eluting stent (DES) implantation are currently limited, although late adverse events beyond 1 year are one of the major concerns of DES. We evaluated long-term clinical outcomes in 134 consecutive patients who underwent sirolimus-eluting stents (SES) for unprotected LMCA lesion in a single center from 2004 to 2009. The median follow-up duration was 3.8 (range: 0.5-7.9) years. Eight patients suffered from serious cardiovascular events potentially related to LMCA lesion (primary outcome measure) (sudden cardiac death: N = 5, emergent coronary revascularization for the LMCA lesion: N = 2, and acute congestive heart failure related to LMCA lesion: N = 1) with the cumulative 5-year incidence of only 4.4 %. The cumulative 5-year incidence of all-cause death, cardiac death, target vessel myocardial infarction, definite stent thrombosis, and target-lesion revascularization was 26.5, 8.1, 0, 0, and 12.9 %, respectively. In a subgroup analysis, the cumulative incidence of the primary outcome measure was significantly higher in patients with 2-stenting (N = 27) than in patients with 1-stenting (N = 107) (14.0 and 2.2 %, P < 0.001). All 8 patients with serious adverse events had a true bifurcation lesion and 5 patients received 2-stenting for the LMCA lesion. SES implantation in patients with unprotected LMCA lesion was associated with a favorable long-term outcome with acceptably low rate of serious adverse event potentially related to LMCA lesion. However, complex LMCA lesions necessitating 2-stenting strategy might be associated with higher risk for serious adverse events.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Hirooki
authors.initials: H
authors.lastname: Higami
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Niki
authors.forename: Junichi
authors.initials: J
authors.lastname: Tazaki
authors.forename: Masao
authors.initials: M
authors.lastname: Imai
authors.forename: Naritatsu
authors.initials: N
authors.lastname: Saito
authors.forename: Takeru
authors.initials: T
authors.lastname: Makiyama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shizuta
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shioi
authors.forename: Koh
authors.initials: K
authors.lastname: Ono
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000473:pathology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D016757:Death, Sudden, Cardiac / Q000209:etiology; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D011183:Postoperative Complications; D011379:Prognosis; D019919:Prosthesis Implantation; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D020123:Sirolimus