Are drug-eluting stents superior to bare-metal stents in patients with unprotected non-bifurcational left main disease? Insights from a multicentre registry

Corrado Tamburino, Maria Elena Di Salvo, Davide Capodanno, Antonio Marzocchi, Imad Sheiban, Massimo Margheri, Aleardo Maresta, Fabio Barlocco, Giuseppe Sangiorgi, Giancarlo Piovaccari, Antonio Bartorelli, Carlo Briguori, Diego Ardissino, Francesco Di Pede, Angelo Ramondo, Luigi Inglese, Anna Sonia Petronio, Leonardo Bolognese, Alberto Benassi, Cataldo PalmieriAldo Patti, Stefano De Servi

Research output: Contribution to journalArticle

Abstract

Aims: To compare long-term clinical outcome following drug-eluting stents (DES) or bare-metal stents (BMS) implantation on lesions located at the ostium or the shaft of the left main in a large real-world population. The advent of DES decreased the risk of unprotected left main coronary artery (ULMCA) restenosis when compared with BMS, but it is unclear if this advantage continues when non-bifurcational lesions are considered.Methods and resultsThe GISE-SICI registry is a retrospective, observational multicentre registry promoted by the Italian Society of Invasive Cardiology in which 19 high-volume participating centres enrolled 1453 consecutive patients who underwent percutaneous coronary intervention on ULMCA between January 2002 and December 2006. From the registry, a total of 479 consecutive patients with ostial and shaft lesions who underwent DES (n = 334) or BMS (n = 145) implantation were analysed with extensive multivariable and propensity score adjustments. At 3-year follow-up, risk-adjusted survival rates were higher in patients treated with DES than in those treated with BMS. The adjusted hazard ratio (HR) for the risk of mortality after DES implantation relative to BMS implantation was 0.37 (95 CI: 0.15-0.96, P = 0.04). The adjusted HR for the risk of cardiac mortality was 0.31 (95 CI: 0.09-1.04, P = 0.06). The adjusted 3-year rates of target lesion revascularization (TLR) were not significantly lower in the DES group than in the BMS group (P = 0.60).ConclusionIn a large population of patients with lesions located at the ostium or the shaft of the left main in a real-world setting, DES were associated with favourable clinical outcomes when compared with BMS, although there was no evidence of a significant reduction in TLR with DES vs. BMS.

Original languageEnglish
Pages (from-to)1171-1179
Number of pages9
JournalEuropean Heart Journal
Volume30
Issue number10
DOIs
Publication statusPublished - May 2009

Keywords

  • Drug-eluting stent
  • Restenosis
  • Unprotected left main

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Tamburino, C., Di Salvo, M. E., Capodanno, D., Marzocchi, A., Sheiban, I., Margheri, M., Maresta, A., Barlocco, F., Sangiorgi, G., Piovaccari, G., Bartorelli, A., Briguori, C., Ardissino, D., Di Pede, F., Ramondo, A., Inglese, L., Petronio, A. S., Bolognese, L., Benassi, A., ... De Servi, S. (2009). Are drug-eluting stents superior to bare-metal stents in patients with unprotected non-bifurcational left main disease? Insights from a multicentre registry. European Heart Journal, 30(10), 1171-1179. https://doi.org/10.1093/eurheartj/ehp052