Author + information
- Mamoru Toyofuku,
- Takeshi Kimura,
- Takeshi Morimoto,
- Yasuhiko Hayashi,
- Nobuo Shiode,
- Kazuaki Mitsudo,
- On Behalf of J–Cypher Registry
We assessed 5–year outcomes after implantation of sirolimus–eluting stent (SES) for unprotected left main coronary artery (ULMCA) disease in comparison with that for non–left main disease.
Methods and Results
The j–Cypher is a multicenter prospective registry of consecutive patients undergoing SES implantation in Japan. Among 12,812 patients enrolled in the j–Cypher registry, unadjusted mortality rate at 5 years was significantly higher in patients with ULMCA stenting (n=582) than in patients without ULMCA stenting (n=12230) (22.8% versus 14.1%, P<0.0001); however, the risk of ULMCA stenting for death was no longer significant after adjusting for confounders (hazard ratio 1.18, 95% confidence interval 0.95 to 1.46, P=0.14). In the lesion–level comparison, the 96 non–bifurcation ULMCA lesions treated exclusively with SES had a significantly lower rate of target–lesion revascularization (TLR) than those in non–ULMCA non–bifurcation lesions (n=13249) (2.4% versus 12.7%, P=0.04). Among bifurcation lesions, those treated with provisional two–approach had similar rates of TLR (12.1% versus 11.4%; P=0.79) between the ULMCA (n=281) and non–ULMCA (n=1433) groups. Lesions treated with elective two stent had higher TLR rates in ULMCA group (n=99) as compared with non–ULMCA group (n=217) (33.5% versus 19.7%, P=0.002).
The safety of ULMCA stenting relative to non–LMCA stenting was maintained through 5 years follow–up. In terms of efficacy, SES implantation in non–bifurcation ULMCA lesions was associated with an extremely low cumulative incidence of TLR, while elective two–stent approach for ULMCA bifurcation lesions was associated with markedly higher cumulative incidence of TLR as compared with that for non–ULMCA bifurcation lesions.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Left Main and Bifurcation Intervention
Abstract Category: 46. TCT@ACC–i2: Coronary Intervention, LM/Bifurcations
Presentation Number: 2105–249
- 2013 American College of Cardiology Foundation