Abstract 4339: Five Year Outcomes in Patients With Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stent Implantation: Milan Experience
Background: Encouraging results have been reported at mid-term clinical follow-up in some observational registries with elective drug-eluting stent (DES) implantation in left main coronary artery (LMCA).
Methods: All consecutive patients who underwent elective implantation of either sirolimus- (SES, Cypher, Cordis, Johnson and Johnson Company, Warren, NJ) or paclitaxel-eluting stent (PES, Taxus, Boston Scientific, Natick, MA) for de novo lesions on LMCA between March 2002 and June 2004 were analyzed.
Results: A total of 107 pts were treated: 52 with PES and 55 with SES implantation. High mortality risk scores (Euroscore >6) were present in 34 (31.7%) of the pts. Eighty-seven (81.3%) patients had a distal left main lesion location. A double stent technique was preferred in 64 (73.6%) pts. At 5 years, 17 (15.9%) patients died; among them 8 (7.5%) were adjudicated as cardiac deaths according to ARC definition. Six of the cardiac deaths could be considered as possible late stent thrombosis (ST). Only 1 pt had a definite late ST at 3.9 months while on double antiplatelet therapy (DAT). No patient had a probable ST. Angiographic follow-up was performed in 93 pts (86.9%). TVR (defined as any revascularization in left coronary system) occurred in 30 (28.0%) pts (24 re-PCI and 6 CABG) and TLR (defined as any revascularization in the stented segment) in 20 (18.7%); all of them occurred in pts with treatment of distal LMCA. At 5-year follow-up freedom from death, MI and cerebrovascular events was 82.4%.
Conclusion: Treatment of LMCA stenosis with DES appears to be safe and with favorable clinical results maintained at very long term (five years) clinical follow-up.