Published online before print February 7, 2005, doi: 10.1161/01.CIR.0000155256.88940.F8
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(Circulation. 2005;111:791-795.)
© 2005 American Heart Association, Inc.
Interventional Cardiology |
Early and Mid-Term Results of Drug-Eluting Stent Implantation in Unprotected Left Main
From San Raffaele Hospital (A.C., E.T., M.M., F.A., I.M., M.C., G.V., A.C.) and Columbus Hospital (I.I., M.S., A.C.) and Institute of Medical Statistics and Biometry, University of Milan (E.B.), Milan, Italy; and the Institute for Cardiovascular Disease (G.S.), Clinical Center of Serbia, Belgrade, Serbia and Montenegro.
Correspondence to Antonio Colombo, MD, EMO Centro Cuore Columbus, Via M. Buonarroti 48, 20145 Milan, Italy. E-mail colombo{at}emocolumbus.it
Received July 9, 2004; revision received October 31, 2004; accepted November 5, 2004.
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.
Key Words: revascularization • stents, drug-eluting • arteries
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Circulation 2005 111: 717.
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|
|
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|
|
|
|
|
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|
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|
|
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|
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|
|
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|
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|
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|
|
|
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|
|
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|
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|
|
|
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