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(Circulation. 2009;119:2349-2356.)
© 2009 American Heart Association, Inc.

Interventional Cardiology

Unprotected Left Main Stenting in the Real World

Two-Year Outcomes of the French Left Main Taxus Registry

Beatriz Vaquerizo, MD; Thierry Lefèvre, MD; Olivier Darremont, MD; Marc Silvestri, MD; Yves Louvard, MD; Jean Louis Leymarie, MD; Philippe Garot, MD; Helen Routledge, MD; Federico de Marco, MD; Thierry Unterseeh, MD; Marcel Zwahlen, PhD; Marie-Claude Morice, MD

From the Institut Cardiovasculaire Paris Sud (B.V., T.L., Y.L., H.R., F.d.M., M.-C.M.), Institut hospitalier Jacques Cartier, Massy, France; Clinique Saint-Augustin (O.D., J.L.L.), Bordeaux, France; Clinique du Parc Rambot (M.S.), Aix En Provence, France; Institut Cardiovasculaire Paris Sud (P.G., T.U.), Hopital Claude Galien, Quincy, France; and Institute of Social and Preventive Medicine (M.Z.), Bern University, Bern, Switzerland.

Reprint requests to Dr Thierry Lefèvre, MD, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France. E-mail beavaquerizo{at}yahoo.es

Received July 5, 2008; accepted March 4, 2009.

Background— Cardiac surgery is the reference treatment for patients with left main (LM) disease, although percutaneous coronary intervention with drug-eluting stents is emerging as a possible alternative. The objective of this registry was to evaluate the 2-year outcome of elective percutaneous coronary intervention for unprotected LM disease with paclitaxel-eluting stents.

Methods and Results— A total of 291 patients were prospectively included from 4 centers. Acute myocardial infarction and cardiogenic shock were the only exclusion criteria. Patients were 69±11 years old, 29% were diabetic, and 25% had 3-vessel disease. For distal LM lesions (78%), the provisional side-branch T-stenting approach was used in 92% of cases and final kissing balloon inflation in 97%. Angiographic success was obtained in 99.7% of cases. At 2-year follow-up, the total cardiac death rate was 5.4% (1 EuroSCORE point was associated with a 15% [95% confidence interval 2.9% to 28.2%, P=0.013] higher risk of cardiac death), target-lesion revascularization was 8.7%, and incidence of Q-wave or non–Q-wave myocardial infarction was 0.9% and 3.1%, respectively. The combined end point occurred in 15.8% of cases and stroke in 0.7%. The incidence of definite and probable LM stent thrombosis was 0.7%, whereas the incidence of any stent thrombosis was 3.8%, with a higher risk in patients with side-branch stenting in the presence of LM bifurcation lesions (hazard ratio 9.6, 95% confidence interval 1.2 to 77.7, P=0.035).

Conclusions— Unprotected LM stenting with paclitaxel-eluting stents, with a strategy of provisional side-branch T-stenting for distal lesions, provides excellent acute angiographic results and good mid-term clinical outcomes, with a 15.8% rate of major adverse cardiac events at 2-year follow-up.

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CLINICAL PERSPECTIVE

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