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Stenting Left Main

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Outcomes Among Patients Undergoing Distal Left Main Percutaneous Coronary Intervention Left Main Revascularization With PCI or CABG in Patients With Chronic Kidney Disease: EXCEL Trial Design and rationale for a randomised comparison of everolimus-eluting stents and coronary artery bypass graft surgery in selected patients with left main coronary artery disease: the EXCEL trial Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease Successful bailout stenting strategy against lethal coronary dissection involving left main bifurcation Radial versus femoral artery access in patients undergoing PCI for left main coronary artery disease: analysis from the EXCEL trial Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European Bifurcation Club Contemporary Approach to Coronary Bifurcation Lesion Treatment Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial
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Clinical Trial2012 Oct 2;60(14):1217-22.

JOURNAL：J Am Coll Cardiol. Article Link

Clinical and angiographic outcomes of patients treated with everolimus-eluting stents or first-generation Paclitaxel-eluting stents for unprotected left main disease

Valenti R, Migliorini A, Parodi G et al. Keywords: drug-eluting stent(s); everolimus-eluting stent(s); paclitaxel-eluting stent(s)

ABSTRACT

OBJECTIVES - The goal of this study was to compare the outcomes of patients treated with everolimus-eluting stents (EES) with outcomes of patients treated with first-generation paclitaxel-eluting stents (PES) for unprotected left main disease (ULMD).


BACKGROUND - No data exist about the comparison of these 2 types of stents in ULMD.

METHODS - The primary endpoint of the study was a 1-year composite of cardiac death, nonfatal myocardial infarction, target vessel revascularization, and stroke (MACE). Secondary endpoints were 1-year target vessel failure (TVF) and 9-month angiographic in-segment restenosis >50%.

RESULTS - From 2004 to 2010, a total of 390 patients underwent ULMD percutaneous coronary intervention (224 received PES and 166 EES). The 1-year MACE rate was 21.9% in the PES group and 10.2% in the EES group (p = 0.002). TVF rate was 20.5% in the PES group and 7.8% in the EES group (p < 0.001). The in-segment restenosis rate was 5.2% in the EES group and 15.6% in the PES group (p = 0.002). EES and EuroSCORE were the only variables related to the risk of MACE. EES (odds ratio: 0.32; p = 0.007) was also independently related to the risk of restenosis.

CONCLUSIONS - EES implantation for ULMD is associated with a reduced incidence of 1-year MACE, TVF, and restenosis as compared with PES implantation.

Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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