Abstract 2523: Long-Term Safety and Effectiveness of Unprotected Left Main Coronary Stenting with Drug-Eluting Stent Compared with Bare-Metal Stent
Background: Limited information is available on long-term outcomes for patients with unprotected left main coronary artery (LMCA) disease who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
Design, Setting, and Patients: To compare long-term outcomes of PCI with DES versus bare-metal stents (BMS) in the MAIN-COMPARE registry, 1217 consecutive patients receiving PCI were enrolled. Of those, 353 received only BMS and 864 received at least 1 DES. The 3-year outcomes were compared using the propensity-score matching in the entire and separate populations according to the lesion location.
Results: Patients receiving DES were older and had a higher prevalence of diabetes mellitus, hypertension, hyperlipidemia, three vessel disease, and prior history of PCI, and were treated with longer stents. In 255 matched-pairs of overall population (Figure⇓), the 3-year risk of death or myocardial infarction was comparable with use of DES or BMS (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.52–1.43). However, the risk of target lesion revascularization was significantly lower with DES than with BMS (HR, 0.43; 95% CI, 0.20 – 0.88). When the patients were stratified according to lesion location, DES was still associated with target lesion revascularization in 96 matched-pairs of patients with bifurcation lesions (HR, 0.13; 95% CI, 0.03– 0.58) or 156 matched-pairs of patients with non-bifurcation lesions (HR, 0.40; 95% CI, 0.15–1.06) with a comparable risk of death or MI.
Conclusions: Compared with BMS, DES reduces the need for repeat revascularization, without increasing the risk of death or MI for patients with unprotected LMCA stenosis.