Article Text
Abstract
Background: Percutaneous coronary intervention (PCI) of left main coronary artery (LMCA) disease in the bare stent era was limited by high restenosis rates which eventually resulted in sudden death in unprotected cases. Clinical and angiographic restenosis has been substantially reduced by drug-eluting stents, reviving therefore this indication for PCI despite the absence of direct comparative studies with coronary artery bypass graft surgery.
Objective: To assess the acute, mid- and long-term outcomes of patients treated with sirolimus-eluting stents for unprotected LMCA stenoses and to compare them with those treated for protected LMCA disease in the same time period from the German Cypher Registry.
Setting and patients: The German Cypher Registry included 6755 patients. Eighty-two patients treated for unprotected LMCA disease were compared with 118 patients treated for protected LMCA stenoses. All patients were treated by sirolimus-eluting stents. The primary end point was death, myocardial infarction (MI) and target vessel revascularisation at 6 months’ follow-up. Survival free of MI at the long term was considered as the safety end point.
Results: One-third of the patients in both groups were treated for the distal left main bifurcation. Angiographic success was 98.5% for both groups. The cumulative combined incidence of all-cause death, non-fatal MI and target vessel revascularisation at 6 months was 14.1% in the unprotected LMCA group and 13.1% in the protected group (hazard ratio = 0.81 (95% CI 0.37 to 1.74), p = 0.8). At long-term, death/MI were reported among 20.2% (95% CI 13.5% to 29.6%) of the protected group versus 11.8% (95% CI 6.3% to 21.4%) of the unprotected group (p = 0.2).
Conclusion: Sirolimus-eluting stent treatment of unprotected and protected LMCA stenoses is technically feasible in widespread routine clinical use. Acceptable long-term clinical results can be achieved, with no particular safety concerns about treatment of unprotected LMCA disease.
- left main coronary artery
- drug-eluting stents
- sirolimus
- angioplasty
Statistics from Altmetric.com
Footnotes
The design of the German Cypher Stent Registry as well as the collection, analysis and interpretation of the data were all independent of Cordis Corporation, a Johnson & Johnson company, who supported the study by an unrestricted grant.
Conflict of interest: None. Mr Pfannebecker is an employee of Cordis, Germany.
- Abbreviations:
- BMS
- bare metal stents
- CABG
- coronary artery bypass graft
- DES
- drug-eluting stents
- HR
- hazard ratio
- LMCA
- left main coronary artery
- MI
- myocardial infarction
- PCI
- percutaneous coronary intervention
- SES
- sirolimus-eluting stent
- STEMI
- ST-elevation myocardial infarction
- TLR
- target lesion revascularisation
- TVR
- target vessel revascularisation
Linked Articles
- Featured correspondence
- Correction