Sirolimus- vs. paclitaxel-eluting stents for the treatment of unprotected left main coronary artery stenosis: Complete 2-year follow-up of a two-center registry

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Abstract

Background

The feasibility of percutaneous coronary intervention (PCI) using drug-eluting stents and its comparability with bypass surgery in treatment of unprotected left main coronary artery (LMCA) stenosis has been shown previously. We compared the mid-to long-term outcome between sirolimus-(SES) vs. paclitaxel-eluting stents (PES) in an all-comer analysis that included all patients with unprotected LMCA stenosis who underwent PCI with SES or PES.

Methods

From March 2003 and June 2007, 196 patients underwent PCI with SES or PES for unprotected LMCA stenosis at Seoul National University Main or Bundang Hospital; SES was implanted in 141 patients and PES in 55 patients. The baseline clinical and procedural characteristics were mostly similar between the SES and PES group.

Results

After 2 years of follow-up, there were no differences in the rate of cardiac death (9.1% vs. 8.5%) and nonfatal MI (5.5% vs. 2.8%) between the two groups. However, the risk of repeat revascularization tended to be lower in the SES group compared with the PES group [TLR, 9.9% vs. 20.0% (P = 0.06); TVR, 17.7% vs. 30.9% (P = 0.05)], which did not reach statistical significance. The rate of stent thrombosis (ST) was also similar between the two groups (3.6% vs. 2.1% for definite ST, 3.6% vs. 2.8% for definite + probable ST).

Conclusions

In all-comers undergoing first generation DES implantation for unprotected LMCA stenosis, PES and SES showed comparable 2-year clinical results regarding hard endpoints and major adverse cardiac events.

Introduction

With the introduction of drug-eluting stents (DES) which was shown to decrease repeat revascularization [1], percutaneous coronary intervention (PCI) has become a possible treatment option for complex and high-risk lesions including unprotected left main coronary artery (LMCA) stenosis. Rising amount of data has shown the feasibility of PCI and its comparability with bypass surgery in patients with unprotected LMCA stenosis [2], [3], [4], [5], [6], [7]. As PCI is performed more widely in patients with LMCA stenosis, the use of optimal procedure techniques and selection of proper stent types deserve attention. Although there have been robust data comparing the performance of sirolimus-(SES) vs. paclitaxel-eluting stents (PES), there is still limited data comparing these 1st generation DESs in unprotected LMCA stenosis. In the present study, we compared 2-year clinical outcome of SES and PES using a two-center left main registry from the Seoul National University Main and Bundang Hospital.

Section snippets

Patients

The analysis was from a two-center DES registry of consecutive patients with LMCA or LMCA equivalent disease treated at Seoul National University Main and Bundang Hospital. We analyzed all patients with unprotected LMCA treated by PCI using first generation DES from March 2003 and June 2007. Unprotected LMCA disease was defined as more than 50% LMCA stenosis, and left main equivalent disease as severe stenosis (≥ 70%) of both left anterior descending (LAD) and left circumflex (LCx) coronary

Baseline characteristics

We identified 196 patients (SES: 141 patients, PES: 55 patients) with unprotected LMCA stenosis who received PCI during the study period. The baseline clinical characteristics of the patients are listed in Table 1. The mean age of the patients was 64.2 ± 11.7 years, 69% were males, and 38% were diabetic. Reflecting the feature of ‘all-comer’ analysis, 38% of the patients had presented with stable angina, while 57% with acute coronary syndrome. While hypertension was more frequent in the PES group,

Discussion

Since the introduction of DES into the commercial market, there have been many comparisons of the first generation SES (Cypher®) and PES (Taxus™) stents in different studies such as the ISAR-DESIRE, REALITY, SORT OUT II, SIRTAX trial [11], [12], [13], [14], [15]. However, there is still paucity of data comparing the two types of stent in unprotected LMCA stenosis. In this study, we compared the outcome of SES vs. PES in unprotected LMCA stenosis. In this analysis, we found that PCI (using SES

Conclusion

In patients with LMCAS, DES implantation was both feasible and safe. Furthermore, PES and SES showed comparable long-term clinical outcomes regarding hard endpoints and MACE.

Acknowledgements

This study was supported by a grant from the Clinical Research Center for Ischemic Heart Disease, Seoul, Republic of Korea (0412-CR02-0704-0001) and a grant from the Innovative Research Institute for Cell Therapy, Seoul National University Hospital (A062260), sponsored by the Ministry of Health, Welfare & Family, Republic of Korea. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [25].

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