Three-Year Outcomes After Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease

Authors:
  • TKTakeshi Kimura
    Takeshi Kimura
  • TMTakeshi Morimoto
    Takeshi Morimoto
  • YHYasuhiko Hayashi
    Yasuhiko Hayashi
  • HUHiroaki Ueda
    Hiroaki Ueda
  • KKKazuya Kawai
    Kazuya Kawai
  • YNYoichi Nozaki
    Yoichi Nozaki
  • SHShinichi Hiramatsu
    Shinichi Hiramatsu
  • AMAkira Miura
    Akira Miura
  • YYYoshiaki Yokoi
    Yoshiaki Yokoi
  • STShinichiro Toyoshima
    Shinichiro Toyoshima
  • HNHitoshi Nakashima
    Hitoshi Nakashima
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Abstract
Background— Long-term outcomes after stenting of an unprotected left main coronary artery (ULMCA) with drug-eluting stents have not been addressed adequately despite the growing popularity of this procedure. 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 3 years was significantly higher in patients with ULMCA stenting (n=582) than in patients without ULMCA stenting (n=12 242; 14.6% versus 9.2%, respectively; P P =0.12). 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 for the ULMCA lesions (3.6% versus 17.1%, P =0.005), with similar cardiac death rates at 3 years (9.8% versus 7.6%, P =0.41). Among patients with bifurcation lesions, patients with stenting of both the main and side branches (n=119) had significantly higher rates of cardiac death (12.2% versus 5.5%; P =0.02) and target-lesion revascularization (30.9% versus 11.1%; P Conclusions— The higher unadjusted mortality rate of patients undergoing ULMCA stenting with a sirolimus-eluting stent did not appear to be related to ULMCA treatment itself but rather to the patients’ high-risk profile. Although long-term outcomes in patients with ostial/shaft ULMCA lesions were favorable, outcomes in patients with bifurcation lesions treated with stenting of both the main and side branches appeared unacceptable.

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