Everolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Stenosis

• DOI: 10.1016/j.jcin.2012.05.002
• Publication Date: 2012-07-18T16:37:32Z
• Authors: Young-Hak Kim; Duk-Woo Park; Jung-Min Ahn; Sung-Cheol Yun; Hae Geun Song; Jong-Young Lee; Won-Jang Kim; Soo-Jin Kang; Seung-Whan Lee; Cheol Whan Lee; Seong-Wook Park; Yangsoo Jang; Myung-Ho Jeong; Hyo-Soo Kim; Seung-Ho Hur; Seung-Woon Rha; Do-Sun Lim; Sung-Ho Her; Ki Bae Seung; In-Whan Seong; Seung-Jung Park
• Keywords: Male; Risk; Sirolimus; Incidence; 610; left main coronary disease; Drug-Eluting Stents; Middle Aged; coronary disease; Coronary Vessels; 3. Good health; Coronary Restenosis; 03 medical and health sciences; 0302 clinical medicine; stents; bypass surgery; Confidence Intervals; Humans; Female; Everolimus; Coronary Artery Bypass; Cardiology and Cardiovascular Medicine; Immunosuppressive Agents

This study sought to evaluate the safety and efficacy of second-generation drug-eluting stents (DES) for patients with unprotected left main coronary artery (ULMCA) stenosis.The clinical benefit of second-generation DES for ULMCA stenosis has not been determined.The authors assessed 334 consecutive patients who received everolimus-eluting stents (EES) for ULMCA stenosis between 2009 and 2010. The 18-month incidence rates of major adverse cardiac or cerebrovascular events (MACCE), including death, myocardial infarction (MI), stroke, or ischemia-driven target vessel revascularization (TVR), were compared with those of a randomized study comparing patients who received sirolimus-eluting stents (SES) (n = 327) or coronary artery bypass grafts (CABG) (n = 272).EES (8.9%) showed a comparable incidence of MACCE as SES (10.8%; adjusted hazard ratio [aHR] of EES: 0.84; 95% confidence interval [CI]: 0.51 to 1.40; p = 0.51) and CABG (6.7%, aHR of EES: 1.40; 95% CI: 0.78 to 2.54; p = 0.26). The composite incidence of death, MI, or stroke also did not differ among patients receiving EES (3.3%), SES (3.7%; aHR of EES: 0.63; 95% CI: 0.27 to 1.47; p = 0.29), and CABG (4.8%; aHR of EES: 0.67; 95% CI: 0.29 to 1.54; p = 0.34). However, the incidence of ischemia-driven TVR in the EES group (6.5%) was higher than in the CABG group (2.6%, aHR of EES: 2.77; 95% CI: 1.17 to 6.58; p = 0.02), but comparable to SES (8.2%, aHR of EES: 1.14; 95% CI: 0.64 to 2.06; p = 0.65). Angiographic restenosis rates were similar in the SES and EES groups (13.8% vs. 9.2%, p = 0.16).Second-generation EES had a similar 18-month risk of MACCE for ULMCA stenosis as first-generation SES or CABG.