This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: 120/19/1866    most recent CIRCULATIONAHA.109.873349v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Toyofuku, M. PubMed PubMed Citation Articles by Toyofuku, M. Related Collections Restenosis Catheter-based coronary interventions: stents Related Article

(Circulation. 2009;120:1866-1874.)
© 2009 American Heart Association, Inc.

Interventional Cardiology

Three-Year Outcomes After Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease

Insights From the j-Cypher Registry

Mamoru Toyofuku, MD; Takeshi Kimura, MD; Takeshi Morimoto, MD; Yasuhiko Hayashi, MD; Hiroaki Ueda, MD; Kazuya Kawai, MD; Yoichi Nozaki, MD; Shinichi Hiramatsu, MD; Akira Miura, MD; Yoshiaki Yokoi, MD; Shinichiro Toyoshima, MD; Hitoshi Nakashima, MD; Kazuo Haze, MD; Masaru Tanaka, MD; Shunsuke Take, MD; Shigeru Saito, MD; Takaaki Isshiki, MD; Kazuaki Mitsudo, MD, on Behalf of the j-Cypher Registry Investigators

From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai Hospital (Y.Y.), Kishiwada, Japan; Nanpuh Hospital (S. Toyoshima), Kagoshima, Japan; National Hospital Organization Kagoshima Medical Center (H.N.), Kagoshima, Japan; Osaka City General Hospital (K.H.), Osaka, Japan; Osaka Red Cross Hospital (M. Tanaka), Osaka, Japan; Saiseikai Noe Hospital (S. Take), Osaka, Japan; Shonan Kamakura General Hospital (S.S.), Kamakura, Japan; Teikyo University Hospital (T.I.), Tokyo, Japan; and Kurashiki Central Hospital (K.M.), Kurashiki, Japan.

Correspondence to Takeshi Kimura, Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. E-mail taketaka{at}kuhp.kyoto-u.ac.jp

Received April 27, 2009; accepted September 1, 2009.

Background— Long-term outcomes after stenting of an unprotected left main coronary artery (ULMCA) with drug-eluting stents have not been addressed adequately despite the growing popularity of this procedure.

Methods and Results— j-Cypher is a multicenter prospective registry of consecutive patients undergoing sirolimus-eluting stent implantation in Japan. Among 12 824 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 3 years was significantly higher in patients with ULMCA stenting (n=582) than in patients without ULMCA stenting (n=12 242; 14.6% versus 9.2%, respectively; P<0.0001); however, there was no significant difference between the 2 groups in the adjusted risk of death (hazard ratio 1.23, 95% confidence interval 0.95 to 1.60, P=0.12). Among 476 patients whose ULMCA lesions were treated exclusively with a sirolimus-eluting stent, patients with ostial/shaft lesions (n=96) compared with those with bifurcation lesions (n=380) had a significantly lower rate of target-lesion revascularization for the ULMCA lesions (3.6% versus 17.1%, P=0.005), with similar cardiac death rates at 3 years (9.8% versus 7.6%, P=0.41). Among patients with bifurcation lesions, patients with stenting of both the main and side branches (n=119) had significantly higher rates of cardiac death (12.2% versus 5.5%; P=0.02) and target-lesion revascularization (30.9% versus 11.1%; P<0.0001) than those with main-branch stenting alone (n=261).

Conclusions— The higher unadjusted mortality rate of patients undergoing ULMCA stenting with a sirolimus-eluting stent did not appear to be related to ULMCA treatment itself but rather to the patients’ high-risk profile. Although long-term outcomes in patients with ostial/shaft ULMCA lesions were favorable, outcomes in patients with bifurcation lesions treated with stenting of both the main and side branches appeared unacceptable.

---

 

CLINICAL PERSPECTIVE

Related Article:

Clinical Summaries
Circulation 2009 120: 1843-1844. [Extract] [Full Text]