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J Am Coll Cardiol, 2005; 45:351-356, doi:10.1016/j.jacc.2004.10.039
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis

Comparison with bare metal stent implantation

Seung-Jung Park, MD, PHD*,*, Young-Hak Kim, MD*, Bong-Ki Lee, MD*, Seung-Whan Lee, MD*, Cheol Whan Lee, MD, PHD*, Myeong-Ki Hong, MD, PHD*, Jae-Joong Kim, MD, PHD*, Gary S. Mintz, MD{dagger} and Seong-Wook Park, MD, PHD*

* Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
{dagger} Cardiovascular Research Foundation, New York, New York.

Manuscript received July 27, 2004; revised manuscript received September 27, 2004, accepted October 4, 2004.

* Reprint requests and correspondence: Dr. Seung-Jung Park, Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea (Email: sjpark{at}amc.seoul.kr).

OBJECTIVES: This study was designed to compare the clinical and angiographic outcomes of sirolimus-eluting stent (SES) and bare metal stent (BMS) implantation for unprotected left main coronary artery (LMCA) stenosis.

BACKGROUND: The safety and effectiveness of SES implantation for unprotected LMCA stenosis have not been ascertained.

METHODS: Elective SES implantation for de novo unprotected LMCA stenosis was performed in 102 consecutive patients with preserved left ventricular function from March 2003 to March 2004. Data from this group were compared to those from 121 patients treated with BMS during the preceding two years.

RESULTS: Compared to the BMS group, the SES group received more direct stenting, had fewer debulking atherectomies, had a greater number of stents, had more segments stented, and underwent more bifurcation stenting. The procedural success rate was 100% for both groups. There were no incidents of death, stent thrombosis, Q-wave myocardial infarction (MI), or emergent bypass surgery during hospitalization in either group. Despite less acute gain (2.06 ± 0.56 mm vs. 2.73 ± 0.73 mm, p < 0.001) in the SES group, SES patients showed a lower late lumen loss (0.05 ± 0.57 mm vs. 1.27 ± 0.90 mm, p < 0.001) and a lower six-month angiographic restenosis rate (7.0% vs. 30.3%, p < 0.001) versus the BMS group. At 12 months, the rate of freedom from death, MI, and target lesion revascularization was 98.0 ± 1.4% in the SES group and 81.4 ± 3.7% in the BMS group (p = 0.0003).

CONCLUSIONS: Sirolimus-eluting stent implantation for unprotected LMCA stenosis appears safe with regard to acute and midterm complications and is more effective in preventing restenosis compared to BMS implantation.

Abbreviations and Acronyms
  BMS = bare metal stent
  CSA = cross-sectional area
  EEM = external elastic membrane
  IVUS = intravascular ultrasound
  LCX = left circumflex artery
  LMCA = left main coronary artery
  MACE = major adverse cardiac event
  MI = myocardial infarction
  QCA = quantitative coronary angiography
  SES = sirolimus-eluting stent




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