title: Comparison of the efficacy of drug-eluting stents versus bare-metal stents for the treatment of left main coronary artery disease.
abstract: BACKGROUND
  Recent studies reported that percutaneous coronary intervention with stent implantation was safe and feasible for the treatment of left main coronary artery (LMCA) disease in select patients. However, it is unclear whether drug-eluting stents (DESs) have better outcomes in patients with LMCA disease compared with bare-metal stent (BMS) during long-term follow-up in Chinese populations.
  
  
  METHODS
  From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups: 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events (MACEs), including cardiovascular (CV) death, myocardial infarction (MI), and target lesion revascularization (TLR) at 5 years postimplantation.
  
  
  RESULTS
  Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE (19.4% vs. 31.8%, P = 0.022), CV death (7.0% vs. 14.7%, P = 0.045), and MI (5.4% vs. 12.4%, P = 0.049) than the BMS group. There were no significant differences in the rate of TLR (10.9% vs. 17.8%, P = 0.110) and stent thrombosis (4.7% vs. 3.9%, P = 0.758). The rates of MACE (80.6% vs. 68.2%, P = 0.023), CV death (93.0% vs. 85.3%, P = 0.045), TLR (84.5% vs. 72.1%, P = 0.014), and MI (89.9% vs. 80.6%, P = 0.029) free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and MI were 0.41 (95% confidence interval [CI]: 0.21-0.63, P = 0.029) and 0.29 (95% CI: 0.08-0.92, P = 0.037), respectively.
  
  
  CONCLUSIONS
  DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.
authors.forename: Xiao-Zeng
authors.initials: XZ
authors.lastname: Wang
authors.forename: Kai
authors.initials: K
authors.lastname: Xu
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.forename: Quan-Min
authors.initials: QM
authors.lastname: Jing
authors.forename: Hai-Wei
authors.initials: HW
authors.lastname: Liu
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.forename: Geng
authors.initials: G
authors.lastname: Wang
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
authors.forename: Ying-Yan
authors.initials: YY
authors.lastname: Ma
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110840, China.
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Han
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome