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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Sirolimus-Eluting Versus Paclitaxel-Eluting Stent Implantation for the Percutaneous Treatment of Left Main Coronary Artery Disease

A Combined RESEARCH and T-SEARCH Long-Term Analysis

Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands.

Manuscript received June 7, 2005; revised manuscript received August 24, 2005, accepted September 8, 2005.

^_* Reprint requests and correspondence: Prof. Patrick W. Serruys, Thoraxcenter, Bd-406, Dr Molewaterplein 40, 3015-GD Rotterdam, the Netherlands. (Email: p.w.j.c.serruys{at}erasmusmc.nl).

OBJECTIVES: The purpose of this study was to investigate the long-term clinical and angiographic profile of sirolimus-eluting stent (SES) versus paclitaxel-eluting stent (PES) in patients undergoing percutaneous intervention for left main (LM) coronary disease.

BACKGROUND: The long-term clinical and angiographic impact of SES as opposed to PES implantation in this subset of patients is unknown.

METHODS: From April 2002 to March 2004, 110 patients underwent percutaneous intervention for LM stenosis at our institution; 55 patients were treated with SES and 55 with PES. The two groups were well balanced for all baseline characteristics.

RESULTS: At a median follow-up of 660 days (range 428 to 885), the cumulative incidence of major adverse cardiovascular events was similar (25% in the SES group vs. 29%, in the PES group; hazard ratio 0.88 [95% confidence interval 0.43 to 1.82]; p = 0.74), reflecting similarities in both the composite death/myocardial infarction (16% in the SES group and 18% in the PES group) and target vessel revascularization (9% in the SES group and 11% in the PES group). Angiographic in-stent late loss (mm), evaluated in 73% of the SES group and in 77% of the PES group, was 0.32 ± 74 in the main and 0.36 ± 0.59 in the side branch in the SES group vs. 0.46 ± 0.57 (p = 0.36) and 0.52 ± 0.42 (p = 0.41) in the PES group, respectively.

CONCLUSIONS: In consecutive patients undergoing percutaneous LM intervention, PES may perform closely to SES both in terms of angiographic and long-term clinical outcome.

Abbreviations and Acronyms   BMS = bare-metal stent   BR = binary restenosis   CX = left circumflex coronary artery   DES = drug-eluting stent   IVUS = intravascular ultrasound   LAD = left anterior descending coronary artery   LL = late loss   LM = left main coronary artery   MACE = major adverse cardiac events   MI = myocardial infarction   MLD = minimal luminal diameter   PES = paclitaxel-eluting stent   RCA = right coronary artery   SES = sirolimus-eluting stent   TVR = target vessel revascularization

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