| 이종영, 김원장, 박종필, 김경중, 이정우, 박덕우, 이승환, 김영학, 이철환, 홍명기, 박성욱, 박승정 |
Background:
Previous studies show promising results of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with unprotected left main coronary artery (LMCA) disease. This study was aimed to compare the outcomes after two primary DES (sirolimus-eluting stents [SES] vs. paclitaxel-eluting stents [PES]) treatment for unprotected LMCA disease.
Method:
From May 2003 through June 2006, 858 consecutive patients with unprotected LMCA stenosis(50%>) received DES implantation with SES in 669 (78%) patients and PES in 189 (22%) in 12 centers. Stent selection was decided on operator’s discretion. Study end point were death, myocardial infarction (MI), target-vessel revascularization (TVR), stent thrombosis, and major adverse cardiac events (MACE), defined as composite of death, MI or TVR.
Results :
Baseline clinical and angiographic characteristics were comparable between two groups. Mean follow-up duration was 864 ± 340 days. During 3 years of follow-up, there were no significant differences in death (SES vs PES: 9.1 vs 11.0%, Hazard Ratio [HR] 0.88, 95% Confidence Interval [CI] 0.49-1.56, p=0.66), MI (7.8 vs 8.0%, HR 0.95, 95% CI 0.54-1.70, p=0.87), TVR (12.1% vs 10.6%, HR 1.27, 95% CI 0.64-2.51, p=0.49), and MACE (25.8 vs 25.7%, HR 1.02, 95% CI 0.71-1.49, p=0.90). After subsequent multivariable adjustment and propensity-score adjustment, these results were not materially changed. The cumulative incidence of stent thrombosis (definite or probable) were similar (0.6% vs. 1.6%, p=0.18). Renal failure (HR 3.28, 95% CI 2.00-5.39, p<0.001), left ventricular ejection fraction(%) (HR 0.99, 95% CI 0.97-1.00, p=0.04), intravascular ultrasound-guidance (HR 0.63, 95% CI 0.43-0.91, p=0.01), total stent length (mm) (HR 1.01, 95% CI 1.001-1.02, p=0.03), and complex bifurcation stenting (≥2 stents) (HR 1.54, 95% CI 1.02-2.34, p=0.04) were identified as major predictors of MACE.
Conclusion:
DES implantation for unprotective LMCA disease shows favorable long-term clinical outcomes. These findings were consistent irrespective of stent type without significant difference of mortality and repeat revascularization.
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