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(Circulation. 2007;116:158-162.)
© 2007 American Heart Association, Inc.

Interventional Cardiology

Favorable Long-Term Outcome After Drug-Eluting Stent Implantation in Nonbifurcation Lesions That Involve Unprotected Left Main Coronary Artery

A Multicenter Registry

Alaide Chieffo, MD; Seung J. Park, MD, PhD; Marco Valgimigli, MD; Young H. Kim, MD, PhD; Joost Daemen, MD; Imad Sheiban, MD; Alessandra Truffa, MD; Matteo Montorfano, MD; Flavio Airoldi, MD; Giuseppe Sangiorgi, MD; Mauro Carlino, MD; Iassen Michev, MD; Cheol W. Lee, MD, PhD; Myeong K. Hong, MD, PhD; Seong W. Park, MD, PhD; Claudio Moretti, MD; Erminio Bonizzoni, PhD; Renata Rogacka, MD; Patrick W. Serruys, MD, PhD; Antonio Colombo, MD

From the San Raffaele Scientific Institute and Emo Centro Cuore Columbus (A.C., M.M., F.A., G.S., M.C., I.M., R.R., A.C.), Milan, Italy; the Asan Medical Center (S.J.P., Y.H.K., C.W.L., M.K.H., S.W.P.), University of Ulsan College of Medicine, Seoul, Republic of Korea; the Erasmus Medical Center (M.V., J.D., P.W.S.), Thoraxcenter, Rotterdam, the Netherlands; San Giovanni Battista Hospital (I.S., A.T., C.M.), Turin, Italy; and the Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy.

Correspondence to Antonio Colombo, MD, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. E-mail colombo.antonio{at}hsr.it

Received January 23, 2007; accepted May 8, 2007.

Background— The presence of a lumen narrowing at the ostium and the body of an unprotected left main coronary artery but does not require bifurcation treatment is a class I indication of surgical revascularization.

Methods and Results— A total of 147 consecutive patients who had a stenosis in the ostium and/or the midshaft of an unprotected left main coronary artery (treatment of the bifurcation not required) and were electively treated with percutaneous coronary intervention and sirolimus-eluting stents (n=107) or paclitaxel-eluting stents (n=40) in 5 centres were included in this registry. In 72 patients (almost 50%), intravascular ultrasound guidance was performed. Procedural success was achieved in 99% of the patients; in 1 patient with stenosis in the left main coronary artery ostium, a >30% residual stenosis persisted at the end of the procedure, and the patient was referred for coronary artery bypass graft surgery. During hospitalization, no patients experienced a Q-wave myocardial infarction or died. One patient died 19 days after the procedure because of pulmonary infection. At long-term clinical follow-up (886±308 days), 5 patients had died; 7 patients had target vessel revascularization (5 repeat percutaneous coronary interventions and 2 coronary artery bypass graft surgeries), and of these only 1 patient had a target lesion revascularization. Angiographic follow-up was performed in 106 patients (72%) with a late loss of –0.01 mm. Restenosis in the left main trunk occurred only in 1 patient (0.9%).

Conclusions— Percutaneous coronary intervention with sirolimus-eluting stents or paclitaxel-eluting stents implantation in nonbifurcation left main coronary artery lesions appears safe with a long-term major adverse clinical event rate of 7.4% and a restenosis rate of 0.9%.

Key Words: coronary arteries • coronary stenosis • revascularization • stents

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