Published online before print June 18, 2007, doi: 10.1161/CIRCULATIONAHA.107.692178
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(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
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
Related Article:
Circulation 2007 116: 125.
This article has been cited by other articles:
 |
|
 |
|
  F. G. Kushner, M. Hand, S. C. Smith Jr, S. B. King III, J. L. Anderson, E. M. Antman, S. R. Bailey, E. R. Bates, J. C. Blankenship, D. E. Casey Jr, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J. Am. Coll. Cardiol., December 1, 2009; 54(23): 2205 - 2241. [Full Text] [PDF]
|
|
|
|
 |
|
 F. G. Kushner, M. Hand, S. C. Smith Jr, S. B. King III, J. L. Anderson, E. M. Antman, S. R. Bailey, E. R. Bates, J. C. Blankenship, D. E. Casey Jr, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 1, 2009; 120(22): 2271 - 2306. [Full Text] [PDF]
|
|
|
|
|
|
M. Toyofuku, T. Kimura, T. Morimoto, Y. Hayashi, H. Ueda, K. Kawai, Y. Nozaki, S. Hiramatsu, A. Miura, Y. Yokoi, et al. Three-Year Outcomes After Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease: Insights From the j-Cypher Registry Circulation, November 10, 2009; 120(19): 1866 - 1874. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Kandzari, A. Colombo, S.-J. Park, C. L. Tommaso, S. G. Ellis, L. A. Guzman, P. S. Teirstein, C. Tamburino, J. Ormiston, G. W. Stone, et al. Revascularization for unprotected left main disease: evolution of the evidence basis to redefine treatment standards. J. Am. Coll. Cardiol., October 20, 2009; 54(17): 1576 - 1588. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. E. Buszman, P. P. Buszman, R. S. Kiesz, A. Bochenek, B. Trela, M. Konkolewska, D. Wallace-Bradley, M. Wilczynski, I. Banasiewicz-Szkrobka, E. Peszek-Przybyla, et al. Early and Long-Term Results of Unprotected Left Main Coronary Artery Stenting: The LE MANS (Left Main Coronary Artery Stenting) Registry J. Am. Coll. Cardiol., October 13, 2009; 54(16): 1500 - 1511. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Moses, M. B. Leon, and G. W. Stone Left Main Percutaneous Coronary Intervention Crossing the Threshold: Time for a Guidelines Revision! J. Am. Coll. Cardiol., October 13, 2009; 54(16): 1512 - 1514. [Full Text] [PDF]
|
|
|
|
 |
|
 D. O. Williams and J. D. Abbott Diabetes Mellitus Does Not Unsweeten Left Main Intervention J. Am. Coll. Cardiol. Intv., October 1, 2009; 2(10): 964 - 966. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Palmerini, D. Sangiorgi, A. Marzocchi, C. Tamburino, I. Sheiban, M. Margheri, G. Vecchi, G. Sangiorgi, M. Ruffini, A. L. Bartorelli, et al. Ostial and midshaft lesions vs. bifurcation lesions in 1111 patients with unprotected left main coronary artery stenosis treated with drug-eluting stents: results of the survey from the Italian Society of Invasive Cardiology Eur. Heart J., September 1, 2009; 30(17): 2087 - 2094. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Y. Lee, D.-W. Park, S.-C. Yun, S.-W. Lee, Y.-H. Kim, C. W. Lee, M.-K. Hong, S.-W. Park, and S.-J. Park Long-Term Clinical Outcomes of Sirolimus- Versus Paclitaxel-Eluting Stents for Patients With Unprotected Left Main Coronary Artery Disease Analysis of the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) Registry. J. Am. Coll. Cardiol., August 25, 2009; 54(9): 853 - 859. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.-J. Park, Y.-H. Kim, D.-W. Park, S.-W. Lee, W.-J. Kim, J. Suh, S.-C. Yun, C. W. Lee, M.-K. Hong, J.-H. Lee, et al. Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis Circ Cardiovasc Interv, June 1, 2009; 2(3): 167 - 177. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Vaquerizo, T. Lefevre, O. Darremont, M. Silvestri, Y. Louvard, J. L. Leymarie, P. Garot, H. Routledge, F. de Marco, T. Unterseeh, et al. Unprotected Left Main Stenting in the Real World: Two-Year Outcomes of the French Left Main Taxus Registry Circulation, May 5, 2009; 119(17): 2349 - 2356. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Tamburino, M. E. Di Salvo, D. Capodanno, A. Marzocchi, I. Sheiban, M. Margheri, A. Maresta, F. Barlocco, G. Sangiorgi, G. Piovaccari, et al. Are drug-eluting stents superior to bare-metal stents in patients with unprotected non-bifurcational left main disease? Insights from a multicentre registry Eur. Heart J., May 2, 2009; 30(10): 1171 - 1179. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Palmerini, A. Marzocchi, C. Tamburino, I. Sheiban, M. Margheri, G. Vecchi, G. Sangiorgi, A. Santarelli, A. L. Bartorelli, C. Briguori, et al. Temporal pattern of ischemic events in relation to dual antiplatelet therapy in patients with unprotected left main coronary artery stenosis undergoing percutaneous coronary intervention. J. Am. Coll. Cardiol., April 7, 2009; 53(14): 1176 - 1181. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Teirstein Percutaneous Revascularization Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis Circulation, February 24, 2009; 119(7): 1021 - 1033. [Full Text] [PDF]
|
|
|
|
|
|
S.-J. Park and D.-W. Park Percutaneous Coronary Intervention With Stent Implantation Versus Coronary Artery Bypass Surgery for Treatment of Left Main Coronary Artery Disease: Is It Time to Change Guidelines? Circ Cardiovasc Interv, February 1, 2009; 2(1): 59 - 68. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.-J. Park and Y.-H. Kim Current Status of Percutaneous Coronary Intervention With Drug-Eluting Stents in Asia Circulation, December 16, 2008; 118(25): 2730 - 2737. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Wu, E. L. Hannan, G. Walford, and D. P. Faxon Utilization and Outcomes of Unprotected Left Main Coronary Artery Stenting and Coronary Artery Bypass Graft Surgery Ann. Thorac. Surg., October 1, 2008; 86(4): 1153 - 1159. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Chieffo, S.-J. Park, E. Meliga, I. Sheiban, M. S. Lee, A. Latib, Y.-H. Kim, M. Valgimigli, D. Sillano, V. Magni, et al. Late and very late stent thrombosis following drug-eluting stent implantation in unprotected left main coronary artery: a multicentre registry Eur. Heart J., September 1, 2008; 29(17): 2108 - 2115. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Pocar, F. Donatelli, A. Moneta, H. Tomoda, J. A. Tayek, J. R. Arnold, A. P. Banning, S.-J. Park, D.-W. Park, and Y.-H. Kim Stents versus Bypass Grafting for Left Main Coronary Artery Disease N. Engl. J. Med., July 24, 2008; 359(4): 423 - 425. [Full Text] [PDF]
|
|
|
|
|
|
S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369. [Full Text] [PDF]
|
|
|
|
|
|
A. J. White, G. Kedia, J. M. Mirocha, M. S. Lee, J. S. Forrester, W. C. Morales, S. Dohad, S. Kar, L. S. Czer, G. P. Fontana, et al. Comparison of Coronary Artery Bypass Surgery and Percutaneous Drug-Eluting Stent Implantation for Treatment of Left Main Coronary Artery Stenosis J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 236 - 245. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. P. Taggart, S. Kaul, W. E. Boden, T. B. Ferguson Jr, R. A. Guyton, M. J. Mack, P. T. Sergeant, R. J. Shemin, P. K. Smith, and S. Yusuf Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 885 - 892. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Brinker The left main facts: faced, spun, but alas too few. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 893 - 898. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Teirstein Unprotected left main intervention patient selection, operator technique, and clinical outcomes. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 5 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Favorable Results with Drug-Eluting Stents in Nonbifurcation Left Main PCI Journal Watch Cardiology, August 8, 2007; 2007(808): 3 - 3. [Full Text]
|
|