TY - JOUR
T1 - Early and mid-term results of drug-eluting stent implantation in unprotected left main
AU - Chieffo, Alaide
AU - Stankovic, Goran
AU - Bonizzoni, Erminio
AU - Tsagalou, Eleftheria
AU - Iakovou, Ioannis
AU - Montorfano, Matteo
AU - Airoldi, Flavio
AU - Michev, Iassen
AU - Sangiorgi, Massimo Giuseppe
AU - Carlino, Mauro
AU - Vitrella, Giancarlo
AU - Colombo, Antonio
PY - 2005/2/15
Y1 - 2005/2/15
N2 - Background-The safety and efficacy of percutaneous coronary intervention in unprotected left main (ULM) coronary arteries are still a matter of debate. Methods and Results-All consecutive patients who had a sirolimus-eluting stent (Cypher, Cordis, Johnson and Johnson Co) or a paclitaxel-eluting stent (Taxus, Boston Scientific) electively implanted in de novo lesions on unprotected left main were analyzed. Patients treated with a drug-eluting stent (DES) were compared with the historical group of consecutive patients treated with bare metal stent (BMS). Eighty-five patients were treated with DES; 64 had BMS implantation. Patients treated with DES had lower ejection fractions (51.1±11% versus 57.4±13%, P=0.002) and were more often diabetics (21.2% versus 10.9%, P=0.12) with more frequent distal left main involvement (81.2% versus 57.8%, P=0.003). Furthermore, in the DES group, smaller vessels (3.33±0.6 versus 3.7±0.7 mm, respectively; P=0.0001) with more lesions (2.94±1.6 versus 2.25±1.3, P=0.004) and vessels (2.03±0.69 versus 1.8±0.72, P=0.05) were treated with longer stents (24.3±12 versus 15.8±8.6 mm, P=0.0001). Despite the higher-risk patients and lesion profiles in the DES group, the incidence of major cardiac events at a 6-month clinical follow-up was lower in the DES than in the BMS group (20.0% versus 35.9%, respectively; P=0.039). Moreover, cardiac deaths occurred in 3 DES patients (3.5%), as compared with 6 (9.3%) in the BMS group (P=0.17). Conclusions-In this early experience with DES in unprotected left main, this procedure appears safe with favorable and improved clinical results as compared with historical control subjects with a BMS. A randomized study comparing surgery appears justified at present.
AB - Background-The safety and efficacy of percutaneous coronary intervention in unprotected left main (ULM) coronary arteries are still a matter of debate. Methods and Results-All consecutive patients who had a sirolimus-eluting stent (Cypher, Cordis, Johnson and Johnson Co) or a paclitaxel-eluting stent (Taxus, Boston Scientific) electively implanted in de novo lesions on unprotected left main were analyzed. Patients treated with a drug-eluting stent (DES) were compared with the historical group of consecutive patients treated with bare metal stent (BMS). Eighty-five patients were treated with DES; 64 had BMS implantation. Patients treated with DES had lower ejection fractions (51.1±11% versus 57.4±13%, P=0.002) and were more often diabetics (21.2% versus 10.9%, P=0.12) with more frequent distal left main involvement (81.2% versus 57.8%, P=0.003). Furthermore, in the DES group, smaller vessels (3.33±0.6 versus 3.7±0.7 mm, respectively; P=0.0001) with more lesions (2.94±1.6 versus 2.25±1.3, P=0.004) and vessels (2.03±0.69 versus 1.8±0.72, P=0.05) were treated with longer stents (24.3±12 versus 15.8±8.6 mm, P=0.0001). Despite the higher-risk patients and lesion profiles in the DES group, the incidence of major cardiac events at a 6-month clinical follow-up was lower in the DES than in the BMS group (20.0% versus 35.9%, respectively; P=0.039). Moreover, cardiac deaths occurred in 3 DES patients (3.5%), as compared with 6 (9.3%) in the BMS group (P=0.17). Conclusions-In this early experience with DES in unprotected left main, this procedure appears safe with favorable and improved clinical results as compared with historical control subjects with a BMS. A randomized study comparing surgery appears justified at present.
KW - Arteries
KW - Revascularization
KW - Stents, drug-eluting
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U2 - 10.1161/01.CIR.0000155256.88940.F8
DO - 10.1161/01.CIR.0000155256.88940.F8
M3 - Article
C2 - 15699254
AN - SCOPUS:13844267543
VL - 111
SP - 791
EP - 795
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 6
ER -