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Long-term safety and effectiveness of unprotected left main coronary stenting with drug-eluting stents compared with bare-metal stents.

Authors
Kim, YH; Park, DW; Lee, SW; Yun, SC; Lee, CW; Hong, MK; Park, SW; Seung, KB; Gwon, HC; Jeong, MH; Jang, Y; Kim, HS; Seong, IW; Park, HS; Ahn, T; Chae, IH; Tahk, SJ; Chung, WS; Park, SJ; Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization Investigators
Citation
Circulation, 120(5):400-407, 2009
Journal Title
Circulation
ISSN
0009-73221524-4539
Abstract
BACKGROUND: Limited information is available on long-term outcomes for patients with unprotected left main coronary artery disease who received drug-eluting stents (DES). METHODS AND RESULTS: In the multicenter registry evaluating outcomes among patients with unprotected left main coronary artery stenosis undergoing stenting with either bare metal stents (BMS) or DES, 1217 consecutive patients were divided into 2 groups: 353 who received only BMS and 864 who received at least 1 DES. The 3-year outcomes were compared by use of the adjustment of inverse-probability-of-treatment-weighted method. Patients receiving DES were older and had a higher prevalence of diabetes mellitus, hypertension, hyperlipidemia, and multivessel disease. In the overall population, with the use of DES, the 3-year adjusted risk of death (8.0% versus 9.5%; hazard ratio, 0.71; 95% confidence interval, 0.36 to 1.40; P=0.976) or death or myocardial infarction (14.3% versus 14.9%; hazard ratio, 0.83; 95% confidence interval, 0.49 to 1.40; P=0.479) was similar compared with BMS. However, the risk of target lesion revascularization was significantly lower with the use of DES than BMS (5.4% versus 12.1%; hazard ratio, 0.40; 95% confidence interval, 0.22 to 0.73; P=0.003). When patients were classified according to lesion location, DES was still associated with lower risk of target lesion revascularization in patients with bifurcation (6.9% versus 16.3%; hazard ratio, 0.38; 95% confidence interval, 0.18 to 0.78; P=0.009) or nonbifurcation (3.4% versus 10.3%; hazard ratio, 0.39; 95% confidence interval, 0.17 to 0.88; P=0.024) lesions with a comparable risk of death or myocardial infarction. CONCLUSIONS: Compared with BMS, DES was associated with a reduction in the need for repeat revascularization without increasing the risk of death or myocardial infarction for patients with unprotected left main coronary artery stenosis.
MeSH terms
AgedAngioplasty, Balloon, Coronary/statistics & numerical dataCoronary Restenosis/mortality*Coronary Stenosis/mortality*Coronary Stenosis/therapy*Diabetic Angiopathies/epidemiologyDrug-Eluting Stents/statistics & numerical data*FemaleHumansHyperlipidemias/epidemiologyHypertension/epidemiologyIncidenceKaplan-Meier EstimateMaleMetalsMiddle AgedMyocardial Infarction/mortality*PrevalenceRecurrence/prevention & controlRegistries/statistics & numerical dataRisk FactorsSafety
DOI
10.1161/CIRCULATIONAHA.108.800805
PMID
19620506
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Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
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