Background:
The long-term safety and efficacy of drug-eluting stent (DES) implantation in the treatment of unprotected left main coronary artery (LMCA) stenosis is still a matter of debate. Some concerns have been recently raised regarding the risk of late stent thrombosis
Methods:
All consecutive patients (pts) who had sirolimus (SES, Cypher, Cordis, Johnson and Johnson Company, Warren, NJ) or paclitaxel-eluting stent (PES, Taxus, Boston Scientific, Natick, MA) electively implanted in de novo lesions on LMCA between March 2002 and June 2004 were analyzed.
Results:
A total of 107 pts were treated: 52 with PES and 55 with SES. Twenty (18.3%) patients were diabetics, 34 (31.8%) unstable angina, mean age 63.8±10.3 years, EF 52.0±10.4. High mortality risk scores (Euroscore >6) were present in 34 (31.7%) of the patients. Eighty-seven (81.3%) patients had distal left main lesions: 77 bifurcations and 10 trifurcations. Both branches were stented in 64 (73.6%) pts: crush technique was performed in 38 (59.4%) of them. Reference vessel diameter was 3.3±0.68mm. Procedural success was achieved in all pts. During hospitalization 10 (9.3%) patients had CK-MB elevation ≥ 5 ULN. None of the patient had Q wave myocardial infarction (MI), died or had CABG. At 1206±347 days clinical follow-up, 11 (10%) patients died, 8 (7.4%) of them were adjudicated as cardiac deaths according to ARC definition. Five of the cardiac deaths could be considered as possible late stent thrombosis. Only 1 had a definite late stent thrombosis (in the left anterior descending artery with MI treated with re-PCI at 3 months while on dual antiplatelet therapy). TVR (defined as any revascularization in left coronary system) occurred in 26 (24.2%) patients and 19 (17%) TLR (defined as any revascularization in the stented segment): 21 had a re-PCI and 5 CABG. Angiographic follow-up performed in 94 (87.8%) pts showed restenosis in 16 pts (17%); all restenosis occurred in pts with treatment of distal left main and were focal.
Conclusions
Treatment of LMCA stenosis with DES appears safe with favorable and improved clinical results maintained at long term clinical follow-up..
TCT-419 Long-term clinical outcomes of patients presenting with in-stent restenosis after drug-eluting stent implantation for unprotected left main coronary artery. A pooled analysis of the ISAR-LEFT MAIN and ISAR-LEFT MAIN 2 randomized trials