Abstract 2525: Two Year Outcome in Patients with Unprotected Left Main Coronary Artery Stenosis Treated with Drug-Eluting Stent Implantation: Milan and New York Experience
The long-term safety and efficacy of drug-eluting stent (DES) implantation in the treatment of unprotected left main coronary artery (LMCA) stenosis is still a matter of debate. All consecutive patients (pts) who had sirolimus (SES, Cypher, Cordis, Johnson and Johnson Company, Warren, NJ) or paclitaxel-eluting stent (PES, Taxus, Boston Scientific, Natick, MA) electively implanted in de novo lesions on LMCA between March 2002 and July 2006 were analyzed. A total of 267 patients were treated: 107 with PES and 160 with SES. Sixty-four (23.4%) patients were diabetics, 95 (35.6%) had unstable angina, mean age was 64.5±11.6 years and LVEF 52.2±10.7 %. High mortality risk scores (Euroscore >6) were present in 84 (31.5%) of the patients. Glycoprotein IIb/IIIa inhibitors were used in 50 (18.7%) patients, 80 (29.9%) underwent intravascular ultrasound. Distal left main lesions were present in 223 (83.5%) of the patients: 209 bifurcations and 14 trifurcations. Both branches were stented in 108 (48.4%) patients: crush technique was performed in 69 (63.8%) of them. Intra-aortic balloon pump was implanted in 54 (20.2%) of the patients. Reference vessel diameter was 3.3±0.65mm. During hospitalization 32 (11.9 %) patients had CK-MB elevation ≥ 3 ULN. None of the patient had Q wave myocardial infarction (MI) or had CABG. Two patients died of sudden death within 30 days from the procedure while on dual antiplatelet therapy (DAT) and were adjudicated as probable stent thrombosis. At 26 (IQR 19.7.–34.8) month clinical follow-up, 21 (7.8%) patients died, 13 (4.8%) of them were adjudicated as cardiac deaths. Six of the cardiac deaths could be considered as possible late stent thrombosis. Three had a definite (1 a sub-acute and 2 late) stent thrombosis while on DAT, none of them died from the thrombotic event. TVR occurred in 54 (20.2%) patients and TLR in 40 (14.9%) : 49 had a re-PCI and 5 CABG. Angiographic follow-up performed in 201 (75.3%) pts showed restenosis in 38 pts (18%). Despite the high prevalence of distal location in our study population, treatment of unprotected LMCA stenosis with DES appears safe with favorable clinical results maintained at 2 year clinical follow-up.