Abstract 3654: Sirolimus-Eluting Stent Implantation for the Percutaneous Treatment of Unprotected Left Main Coronary Artery Disease: A Clinical Analysis Based on J-Cypher Registry
Objective: The role of stenting in the treatment of left main coronary artery (LMCA) disease using sirolimus-eluting stent (SES) remains controversial.
Subjects and methods: Design of this registry was multi-center prospective enrollment of consecutive patients from 40 centers in Japan. This physician-directed registry has independent database and event committee. From Aug 2004 to Feb 2006, 293 patients received SES for the treatment of unprotected LMCA and followed for 30 days, and 179 patients achieved 6 month follow-up. Among 293 patients, there were 247 electively treated patients [Mean age 70 years, 16% with acute coronary syndrome (ACS) and 11% with congestive heart failure (CHF)] and 46 emergency patients (Mean patient age 71 years, 85% of ACS and 35% of CHF). Patients were divided into two groups of single-stent approach [stenting only in main branch; group S; 214 patients (68%)] and two-stents approach [stenting both in main and side branch; group T; 79 patients (32%)]. Two strategies were selected according to the operators’ discretion. We compared 30 days and 6 months clinical outcomes of both strategies.
Result: Procedure successes were achieved in all patients. In group T, distal LMCA diseases were more commonly observed (96% vs. 66%, P<.0001). Mean LVEF was comparable between the two groups (54% vs 56%, NS). The mortality rates according to the strategies are shown in table⇓. Target lesion revascularization was observed in 2.8% of patients (all in group T) within 6 months.
Conclusion: In our population, SES implantation for unprotected LMCA disease was safe with regard to immediate and mid-term mortality rate. In two-stents approach, the incidences of cardiac mortality appeared to be acceptable, however, relatively high occurrence of sudden cardiac death was observed. Because event numbers are too small to analize the difference of the mortality rate between the two strategies, further enrollment of patients and longer term follow-up are needed.