Abstract 12502: Two-Year Outcomes of Everolimus vs. Paclitaxel Eluting Stents in the Treatment of Unprotected Left Main Lesions
Background: In the era of advancing cardiac technology and the evolution of DES, PCI has appeared as an acceptable alternative to cardiac surgery in the treatment of unprotected left main lesions. It is unknown whether second generation drug-eluting stents (DES) are superior to first generation DES in these patients. Using the data of the French Left Main Taxus registry and the Left Main with Xience stent registry, we sought to compare two-year outcomes of ULM stenting in consecutive patients with ULM lesions who were treated with DES between 2003 and 2008 in 4 French hospitals.
Methods: We performed a matched comparison of the according to 1) Syntax score, 2) stenosis involving the distal LM, 3), provisional side-branch T-stenting and 4) use of one stent in the distal LM to compare two year outcomes for the Everolimus-eluting stent (EES) vs. the Paclitaxel-eluting stent (PES) for LM lesions.
Results: 172 patients were matched from each group. There was no difference between patients treated by either stent with regard to gender (76.5% male), age (mean 69.5±11.3 years), diabetes (25.3%), NSTEMI (40.7%), or LVEF<40% on admission (9.1%). Pts with distal LM lesions (75.9%) were treated using the provisional T stenting strategy in 91.1% with final kissing inflation in 97.5% (p=0.54). The side branch was stented in 22% of patients (p=0.51). Cumulative events 2 years after the procedure are shown in the table below:
Conclusion: Unprotected left main stenting with everolimus-eluting stents is feasible, safe and more effective in the mid-term than ULM stenting with paclitaxel-eluting stents with a reduction in TLF by 53% and TVMI by 47% at two years. Randomized clinical trials with prolonged follow-up will establish the role of these new second generation DES in patients with unprotected LM disease.
- © 2011 by American Heart Association, Inc.