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(Circulation. 2009;120:400-407.)
© 2009 American Heart Association, Inc.

Interventional Cardiology

Long-Term Safety and Effectiveness of Unprotected Left Main Coronary Stenting With Drug-Eluting Stents Compared With Bare-Metal Stents

Young-Hak Kim, MD, PhD; Duk-Woo Park, MD, PhD; Seung-Whan Lee, MD, PhD; Sung-Cheol Yun, PhD; Cheol Whan Lee, MD, PhD; Myeong-Ki Hong, MD, PhD; Seong-Wook Park, MD, PhD; Ki Bae Seung, MD, PhD; Hyeon-Cheol Gwon, MD, PhD; Myung-Ho Jeong, MD, PhD; Yangsoo Jang, MD, PhD; Hyo-Soo Kim, MD, PhD; In-Whan Seong, MD, PhD; Hun Sik Park, MD, PhD; Taehoon Ahn, MD, PhD; In-Ho Chae, MD, PhD; Seung-Jea Tahk, MD, PhD; Wook-Sung Chung, MD, PhD; Seung-Jung Park, MD, PhD, for the Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization Investigators

From the Asan Medical Center, Seoul (Y.-H.K., D.-W.P., S-.W.L., S-.C.Y., C-.W.L., M-.K.H., S-.W.P., S.-J.P.); Catholic University of Korea, GangNam (K.B.S.) and Yeoido (W.-S.C.), Seoul; Samsung Medical Center, Seoul (H.-C.G.); Chonnam National University Hospital, Gwangju (M.-H.J.); Yonsei University Severance Hospital, Seoul (Y.J.); Seoul National University Hospital, Seoul (H.-S.K.) and Bundang (I.-H.C.); Chungnam National University Hospital, Daejeon (I.-W.S.); Kyungpook National University Hospital, Daegu (H.S.P.); Gachon University Gil Medical Center, Incheon (T.A.); and Ajou University Medical Center, Suwon (S-.J.T.), Korea.

Correspondence to Seung-Jung Park, MD, 388–1 Pungnap-dong, Songpa-gu, Seoul, 138–736, South Korea. E-mail sjpark{at}amc.seoul.kr

Received August 14, 2008; accepted June 1, 2009.

Background— Limited information is available on long-term outcomes for patients with unprotected left main coronary artery disease who received drug-eluting stents (DES).

Methods and Results— In the multicenter registry evaluating outcomes among patients with unprotected left main coronary artery stenosis undergoing stenting with either bare metal stents (BMS) or DES, 1217 consecutive patients were divided into 2 groups: 353 who received only BMS and 864 who received at least 1 DES. The 3-year outcomes were compared by use of the adjustment of inverse-probability-of-treatment-weighted method. Patients receiving DES were older and had a higher prevalence of diabetes mellitus, hypertension, hyperlipidemia, and multivessel disease. In the overall population, with the use of DES, the 3-year adjusted risk of death (8.0% versus 9.5%; hazard ratio, 0.71; 95% confidence interval, 0.36 to 1.40; P=0.976) or death or myocardial infarction (14.3% versus 14.9%; hazard ratio, 0.83; 95% confidence interval, 0.49 to 1.40; P=0.479) was similar compared with BMS. However, the risk of target lesion revascularization was significantly lower with the use of DES than BMS (5.4% versus 12.1%; hazard ratio, 0.40; 95% confidence interval, 0.22 to 0.73; P=0.003). When patients were classified according to lesion location, DES was still associated with lower risk of target lesion revascularization in patients with bifurcation (6.9% versus 16.3%; hazard ratio, 0.38; 95% confidence interval, 0.18 to 0.78; P=0.009) or nonbifurcation (3.4% versus 10.3%; hazard ratio, 0.39; 95% confidence interval, 0.17 to 0.88; P=0.024) lesions with a comparable risk of death or myocardial infarction.

Conclusions— Compared with BMS, DES was associated with a reduction in the need for repeat revascularization without increasing the risk of death or myocardial infarction for patients with unprotected left main coronary artery stenosis.

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Circulation 2009 120: 355-356. [Extract] [Full Text]