| 나승운, 박지영, Kanhaiya L. Poddar, Sureshkumar Ramasamy, Lin Wang, 최병걸, 김지박,신승용, 최운정, 최철웅, 임홍의, 김진원, 김응주, 박창규, 서홍석, 오동주 |
Background: Unprotected left main (LM) angioplasty with drug-eluting stent (DES) in patients (pts) has been challenged in ‘real-world clinical practice’. We evaluated the safety and efficacy of DES implantation in LM or its bifurcation lesion regardless of LV dysfunction up to 12 months in a single center LM registry. Methods: All pts with unprotected LM were electively treated with sirolimus-(SES; Cypher), paclitaxel-(PES; Taxus), zotarolimus-(ZES; Endeavor) or everolimus-(EES; Xience) eluting stents. Prophylactic IABP support was done if the EF was less than 40%. All pts received aspirin, clopidogrel (300-600mg) and/or cilostazol as the antiplatelet regimens and unfractionated heparin was given during the PCI. Early and mid-term clinical and angiographic outcomes were evaluated. Results: A total of 117 consecutive pts (73 Males, mean age: 64.1±9.9 years) who underwent standard percutaneous coronary intervention (PCI) with DES in unprotected LM lesion were enrolled. Thirty one pts (31/117, 26.5%, mean EF=35%) had LV dysfunction (moderate in 15 pts, mean EF=28.3%). Type of target lesions were 36 LM bifurcations, 15 LM ostial, 37 LM body to LAD lesions. Seventy two percent (26/36) of LM bifurcation lesions were treated with kissing stenting technique (19 Simultaneous, 9 Sequential). All pts were treated by PES in 26.5% (31/117), SES in 58.1% (68/117), ZES in 13.7% (16/117), and EES in 1.7% (2/117). Mean DES diameter was 3.40 mm and length was 23.5 mm in bifurcation lesions. At 6 months, 13 pts (13/117, 11.1%) showed angiographic binary restenosis. At 12 months, there were 6 total deaths (4 cardiac, 4/117, 2.4%; 2 non-cardiac, 2/117, 1.7%), no Q-wave myocardial infarction (MI), 9 target lesion revascularization (TLR, 9/117, 7.7%) and 14 major adverse cardiac events (MACE, 14/117, 12.0%). Conclusion: Despite the expected higher risk of LM disease, DES implantation in unprotected LM regardless of LV dysfunction appears to be safe and associated with low angiographic restenosis and favorable clinical outcomes up to 12 months
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