Abstract 11547: Five- Year Outcomes after Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease: Insight From the j-Cypher Registry
Background This study assessed 5-year outcomes after the treatment with sirolimus-eluting stent (SES) for unprotected left main coronary artery (ULMCA).
Methods and Results j-Cypher is a multicenter prospective registry of consecutive patients undergoing sirolimus-eluting stent implantation in Japan. Among 12 824 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 5 years was significantly higher in patients with ULMCA stenting (n=582) than in patients without ULMCA stenting (n=12 242; 22.8% versus 14.1%, respectively; P<0.0001); however, the significance was attenuated after the adjustment for confounders (hazard ratio 1.24, 95% confidence interval 0.99 to 1.53, P=0.052). Among 476 patients whose ULMCA lesions were treated exclusively with a sirolimus-eluting stent, patients with ostial/shaft lesions (n=96) compared with those with bifurcation lesions (n=380) had a significantly lower rate of target-lesion revascularization (TLR) for the ULMCA lesions (2.4% versus 17.5%, P=0.0030), with similar cardiac death or MI rates at 5 years (16.6% vs. 15.1%, P=0.68). Among patients with bifurcation lesions, patients with stenting of both the main and side branches (n=119) had similar rates of cardiac death or MI (15.0% versus 15.7%; P=0.48) and higher rates of TLR (12.3% versus 29.6%; P<0.0001) than those with main-branch stenting alone (n=261).
Conclusions The safety of stanting for ULMCA seems to be maintained through 5 years. SES implantation in ostial/shaft lesions was associated with an excellent 5-year TLR rate; and bifurcation 2-stent treatment was associated with higher rates of TLR and similar rate of cardiac death or MI as compared with bifurcation 1-stent treatment.
- © 2011 by American Heart Association, Inc.