Long-Term (4-Year) Outcomes and Predictors of Adverse Cardiac Events After Sirolimus-Eluting Stent Implantation in Unprotected Left Main Coronary Artery

Abstract

SummaryThe long-term safety and efficiency of sirolimus-eluting stent (SES) treatment in unprotected left main coronary artery (ULMCA) have not yet been ascertained.From 2003 to 2006, 126 consecutive patients with de novo lesions in ULMCA who underwent SES were retrospectively analyzed in a single center in China. During 4-year follow-up, major adverse cardiovascular event (MACE)-free survival was 74.6%. Cardiac death occurred in 5 (4.0%), and target lesion revascularization (TLR) and target vessel revascularization (TVR) occurred in 15 (11.9%) and 24 (19.0%) patients, respectively. One (0.8%) experienced probable stent thrombosis while 1 (0.8%) presented possible stent thrombosis. Impaired LVEF (< 40%) and high surgical risk (Euro score > 6) were the independent predictors of MACEs.PCI with SES for de novo lesions in ULMCA is feasible with a low procedural risk. However, SES was associated with a relatively higher rate of TLR and TVR. Impaired LVEF and high surgical risk were important predictors of MACEs. (Int Heart J 2010; 51: 377-382) Key words: Angioplasty, Left main coronary artery stenosis, Sirolimus-eluting stents L eft main stenosis occurs in 4% to 6% of all patients undergoing coronary angiography. 1,2) Preliminary trial results confirmed that implantation of a drug-eluting stent (DES) to treat unprotected left main coronary artery (UL-MCA) disease is feasible and relatively safe in appropriately selected patients.3-9) However, in-stent restenosis and the risk of late thrombosis limit the widespread application of DES, especially because of the potential risk of sudden death associated with ULMCA restenosis. The aim of the present study was to evaluate the long-term clinical outcomes and identify associated predictors for major adverse cardiac events (MACEs) in patients undergoing elective intervention with sirolimus-eluting stents (SES) for ULMCA lesions in a "real-world" setting at a single center in China. ULMCA stenosis who underwent elective PCI with SES were enrolled in this study. Patients presenting with ST-segment elevation myocardial infarction or cardiogenic shock were excluded. All patients provided written informed consent, and the local ethics committee approved the use of clinical data for this study. MethodsThe decision to perform PCI rather than CABG was dependent on either physician or patient preference. Thirty-nine (31%) patients treated with PCI were considered high risk for CABG with a Euroscore > 6 or Parsonnet score > 15. 10,11) Procedural characteristics: All interventions were performed according to concurrent practice guidelines. 12,13) Bifurcation lesions were treated using one of 4 stenting strategies at the discretion of the operator: Crossover, T stent, Culotte stent, or the Crush technique.14,15) Final kissing balloon dilation was mandatory in cases with suboptimal results at the branch ostium. The choice of a particular SES and antithrombotic agent utilized was made by the operator. Overall, 126 patients received SESs including Cypher (Johnson & Johnson, Cordis, Mia...

Intravascular ultrasound-guided unprotected left main coronary artery stenting in the elderly

“…It was defined as death, non-fatal myocardial infarction, and target lesion revascularization (TLR). Target lesion revascularization 8 was defined as a new intervention (percutaneous or surgical) on a previously implanted stent, or within 5 mm of that stent. Deaths were classified as either cardiac or non-cardiac.…”

“…Deaths that could not be classified were considered cardiac according to the Academic Research Consortium definitions. 8 Myocardial infarction 9 was diagnosed by an elevation of serum creatine kinase or troponin 3 times the upper limit of normal, together with chest pain lasting more than 30 minutes.…”

Unprotected left main coronary artery stenting with everolimus (Xience V) drug-eluting stents: A single center retrospective experience

“…In a single-centered registry of patients with lesions treated with PCI with SES, XiaFan Wu et al [21] reported an incidence of cardiac death of 4% and TLR of 1.9% at 3 years of follow-up. Impaired LVEF (<40%) 1 OPEN ACCESS Table 5.…”