Impact of drug-eluting stent selection on long-term clinical outcomes in patients treated for unprotected left main coronary artery disease: The sirolimus vs paclitaxel drug-eluting stent for left main registry (SP-DELFT)

Meliga, Emanuele; García‐García, Héctor M.; Valgimigli, Marco; Chieffo, Alaide; Biondi‐Zoccai, Giuseppe; Maree, Andrew O.; Gonzalo, Nieves; Cook, Stéphane; Marra, Sebastiano; Moretti, Claudio; Servi, Stefano De; Palacios, Igor F.; Windecker, Stephan; Domburg, Ron van; Colombo, Antonio; Sheiban, Imad; Serruys, Patrick W.

doi:10.1016/j.ijcard.2008.06.006

Cited by 22 publications

(19 citation statements)

References 21 publications

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“…17 Therefore, this study supports the contention that a single stent with final kissing balloon inflation for distal left main disease decreases TLR compared with a 2-stent strategy, and according to riskadjusted and propensity score analysis, seems to be safer. The findings of the unadjusted analysis of Palmerini et al are consistent with that of smaller single-center studies, 13,18 other LMCA registries, 19 and randomized studies of PCI with DES for bifurcation lesions outside of the LMCA. 20 The conclusions are strengthened by the relatively large number of patients studied and the duration of follow-up.…”

Section: Article See P 185supporting

confidence: 70%

Change We Can Believe In: The Hyper-Evolution of Percutaneous Coronary Intervention for Unprotected Left Main Disease With Drug-Eluting Stents

Price

Kandzari

Teirstein

2008

Circ: Cardiovascular Interventions

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T he initial adoption of percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) obstruction was tempered by poor acute outcomes after balloon angioplasty and the potential lethality of restenosis in the left main trunk suggested by bare-metal stent registries. 1 The marked antirestenotic efficacy of drug-eluting stents (DES) ushered in a new wave of enthusiasm for unprotected LMCA intervention. However, the accumulation of robust data to guide and support clinical practice has been challenged by the relatively low prevalence of this lesion subset combined with its historical characterization as a "forbidden zone" for PCI. The DES left main database has grown from initial, small, single-center experiences 2-4 to larger multicenter registries, 5 prospective, risk-adjusted comparisons with coronary artery bypass grafting, 6 and most recently to small randomized clinical trials and prespecified subgroups of larger clinical trials. 7,8 Catalyzed by an ethos in interventional cardiology that embraces (1) investigation, (2) dissemination of new information through journals, conferences, and a tradition of live-case demonstration; and (3) rapid adaptation of new techniques, there has been a marked evolution and improvement of the technical approach to unprotected LMCA intervention in a remarkably short period of time. The study reported by Palmerini et al 9 in this issue of the Circulation Cardiovascular Intervention provides further pressure on interventional cardiologists to follow a straightforward maxim: simpler is usually better. Article see p 185The interpretation of the studies of left main PCI with DES has been complicated by heterogeneity within study populations related to both the disease location (ostial, shaft, or distal bifurcation) and the technical approach used (single stent, dedicated 2-stent technique, or provisional stenting of the left main with "bail-out" stenting of the branch vessel). The early, single-center observational studies of DES for the unprotected LMCA demonstrated the dependence of clinical outcome on the anatomic location of the obstruction within the left main: higher major adverse cardiac event (MACE) rates were observed in cohorts with a heavy burden of distal disease 10 and subsequent meta-regression confirmed that distal disease predicted MACE and target vessel revascularization. 11 Centers that frequently used dedicated 2-stent techniques (ie, "crush" or simultaneous kissing stents) 3,4,12 also reported higher target lesion revascularization (TLR) and MACE rates compared with those using a single stent or provisional approach. 13,14 Determining the optimal approach is difficult because stent technique is driven by a combination of clinical and angiographic characteristics and a strong dose of operator preference for which an analysis cannot be easily adjusted. Indeed, the relative predilection to use a single versus 2-stent technique was initially geographic in nature, with a 2-stent approach favored in the United States and parts of Europe, wh...

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Section: Article See P 185supporting

confidence: 70%

Change We Can Believe In: The Hyper-Evolution of Percutaneous Coronary Intervention for Unprotected Left Main Disease With Drug-Eluting Stents

Price

Kandzari

Teirstein

2008

Circ: Cardiovascular Interventions

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“…Overall incidence of definite or probable ST in this study (3.1%) was relatively high when compared to the results of ISAR-LEFT-MAIN study (0.3% for PES, and 1.0% for SES) [17], DE-LFT registry (1.7%) [18], or those reported by Chieffo et al (0.95%) [21]. On the contrary, SYNTAX trial reported 3.3% incidence of ST in patients treated with PES [3].…”

Section: Discussioncontrasting

confidence: 58%

“…Although controversies exist, PES is generally thought to be associated with higher incidence of restenosis than SES [11,14,20]. Previous studies comparing SES and PES in patients with unprotected LMCA stenosis showed similar tendency, which was not statistically significant [7,[17][18][19]. However, the gap between the two stent groups was greater in this study.…”

Section: Discussioncontrasting

confidence: 54%

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Sirolimus- vs. paclitaxel-eluting stents for the treatment of unprotected left main coronary artery stenosis: Complete 2-year follow-up of a two-center registry

Park

Kang

Park

et al. 2011

International Journal of Cardiology

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“…Einige Register zeigten eine erniedrigte kardiovaskuläre Ereignisrate mit DES [135,140], andere eine bessere Überlebensrate nach Bypassoperation [136]. Höhere ISR-Raten bei distalen Hauptstammstenosen im Vergleich zu Schaft-und Ostiumstenosen wurden in einigen [141,142], aber nicht allen [133] Registern berichtet. Häufig wird die PCI der Hauptstammstenose mit DES auch bei ACS durchgeführt [143].…”

Section: Stenosen Des Ungeschützten Hauptstammesunclassified

Medikamente freisetzende Koronarstents und mit Medikamenten beschichtete Ballonkatheter

Scheller

Levenson²,

Joner³

et al. 2011

Kardiologe

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Impact of drug-eluting stent selection on long-term clinical outcomes in patients treated for unprotected left main coronary artery disease: The sirolimus vs paclitaxel drug-eluting stent for left main registry (SP-DELFT)

Cited by 22 publications

References 21 publications

Change We Can Believe In: The Hyper-Evolution of Percutaneous Coronary Intervention for Unprotected Left Main Disease With Drug-Eluting Stents

Change We Can Believe In: The Hyper-Evolution of Percutaneous Coronary Intervention for Unprotected Left Main Disease With Drug-Eluting Stents

Sirolimus- vs. paclitaxel-eluting stents for the treatment of unprotected left main coronary artery stenosis: Complete 2-year follow-up of a two-center registry

Medikamente freisetzende Koronarstents und mit Medikamenten beschichtete Ballonkatheter

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