Self-expandable sirolimus-eluting stents compared to second-generation drug-eluting stents for the treatment of the left main: A propensity score analysis from the SPARTA and the FAILS-2 registries

Antonio Montefusco, Fabrizio D'Ascenzo, Sebastiano Gili, Grzegorz Smolka, Alaide Chieffo, Andreas Baumbach, Javier Escaned, Paolo Sganzerla, Francesco Tomassini, Gioel Gabrio Secco, Fabrizio Ugo, Corrado Tamburino, Annamaria Nicolino, Massimo Mancone, Arnaldo Poli, Kuan Leong Yew, Plinio Cirillo, Wojciech Wanha, Luigi Emilio Pastormerlo, Roberto di SummaGennaro Sardella, Antonio Colombo, Fiorenzo Gaita, Bernardo Cortese

Research output: Contribution to journalArticle

Abstract

Objectives: To compare the effectiveness and safety of self-expandable, sirolimus-eluting Stentys stents (SES) and second-generation drug-eluting stents (DES-II) for the treatment of the unprotected left main (ULM). Background: SES may provide a valuable option to treat distal ULM, particularly when significant caliber gaps with side branches are observed. Methods: Patients from the multicenter SPARTA (clinicaltrials.gov: NCT02784405) and FAILS2 registries were included. Propensity-score with matching was performed to account for the lack of randomization. Primary end-point was the rate of major adverse cardiovascular events (MACE, a composite of all cause death, myocardial infarction, target lesion revascularization [TLR], unstable angina and definite stent thrombosis [ST]). Single components of MACE were the secondary end-points. Results: Overall, 151 patients treated with SES and 1270 with DES-II were included; no differences in MACE rate at 250 days were observed (9.8% vs. 11.5%, P = 0.54). After propensity score with matching, 129 patients treated with SES and 258 with DES-II, of which about a third of female gender, were compared. After a follow-up of 250 days, MACE rate did not differ between the two groups (9.9% vs. 8.5%, P = 0.66), as well as the rate of ULM TLR (1.6% vs. 3.1%, P = 0.36) and definite ST (0.8% vs. 1.2%, P = 0.78). These results were consistent also when controlling for the treatment with provisional vs. 2-stents strategies for the ULM bifurcation. Conclusion: SES use for ULM treatment was associated with a similar MACE rate compared to DES-II at an intermediate-term follow-up. SES might represent a potential option in this setting.

Original languageEnglish
Pages (from-to)208-215
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume93
Issue number2
DOIs
Publication statusPublished - Feb 1 2019

Keywords

  • percutaneous coronary intervention
  • second-generation drug-eluting stent
  • self-expandable stent
  • unprotected left main

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Montefusco, A., D'Ascenzo, F., Gili, S., Smolka, G., Chieffo, A., Baumbach, A., Escaned, J., Sganzerla, P., Tomassini, F., Secco, G. G., Ugo, F., Tamburino, C., Nicolino, A., Mancone, M., Poli, A., Yew, K. L., Cirillo, P., Wanha, W., Pastormerlo, L. E., ... Cortese, B. (2019). Self-expandable sirolimus-eluting stents compared to second-generation drug-eluting stents for the treatment of the left main: A propensity score analysis from the SPARTA and the FAILS-2 registries. Catheterization and Cardiovascular Interventions, 93(2), 208-215. https://doi.org/10.1002/ccd.27809