Short- and long-term clinical outcome after drug-eluting stent implantation for the percutaneous treatment of left main coronary artery disease: Insights from the Rapamycin-Eluting and Taxus Stent Evaluated at Rotterdam Cardiology Hospital Registries (RESEARCH and T-SEARCH)

Erasmus Medical Center, Rotterdam, The Netherlands.
Circulation (Impact Factor: 14.43). 04/2005; 111(11):1383-9. DOI: 10.1161/01.CIR.0000158486.20865.8B
Source: PubMed


The impact of drug-eluting stent (DES) implantation on the incidence of major adverse cardiovascular events in patients undergoing percutaneous intervention for left main (LM) coronary disease is largely unknown.
From April 2001 to December 2003, 181 patients underwent percutaneous coronary intervention for LM stenosis at our institution. The first cohort consisted of 86 patients (19 protected LM) treated with bare metal stents (pre-DES group); the second cohort comprised 95 patients (15 protected LM) treated exclusively with DES. The 2 cohorts were well balanced for all baseline characteristics. At a median follow-up of 503 days (range, 331 to 873 days), the cumulative incidence of major adverse cardiovascular events was lower in the DES cohort than in patients in the pre-DES group (24% versus 45%, respectively; hazard ratio [HR], 0.52 [95% CI, 0.31 to 0.88]; P=0.01). Total mortality did not differ between cohorts; however, there were significantly lower rates of both myocardial infarction (4% versus 12%, respectively; HR, 0.22 [95% CI, 0.07 to 0.65]; P=0.006) and target vessel revascularization (6% versus 23%, respectively; HR, 0.26 [95% CI, 0.10 to 0.65]; P=0.004) in the DES group. On multivariate analysis, use of DES, Parsonnet classification, troponin elevation at entry, distal LM location, and reference vessel diameter were independent predictors of major adverse cardiovascular events.
When percutaneous coronary intervention is undertaken at LM lesions, routine DES implantation, which reduces the cumulative incidence of myocardial infarction and the need for target vessel revascularization compared with bare metal stents, should currently be the preferred strategy.

Download full-text


Available from: Patrick W Serruys
  • Source
    • "Furthermore, the predilection of LMCAD for locations in the distal bifurcation makes PCI a challenge for interventional cardiologists, regardless of the type of device and the technique used. Moreover, 70-80% of patients have concomitant 3-VD5-7,19,29-32 and, combined with the relative frequency of distal bifurcation lesions (53-90% of patients) extending into the proximal coronary arteries (Cx, LAD),7,30,31,33 may favor CABG over PCI for LM stenosis to enable more complete surgical revascularization. In the present study, 50% of the patients with LMCAD suffered from 3-VD (39% in the PCI group vs. 60% in the CABG group, p=0.002), and, in 75% of cases, the lesion was located in the distal LM (59% in PCI group vs. 87% in CABG group, p<0.001). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Coronary artery bypass grafting (CABG) is the optimal treatment option for left main coronary artery disease (LMCAD). However, LMCAD remains a constant topic of discussion between cardiac surgeons and interventional cardiologists. The aim of this study was to assess the efficacy of LMCAD treatments by comparing the mid-term outcomes of CABG and percutaneous coronary intervention (PCI) using bare metal stents or drug-eluting stents (DESs). The study population was comprised of 199 consecutive patients admitted with unprotected LMCAD. All of the patients were assigned to PCI (88 patients) or CABG (111 patients). The primary clinical end point indicated death, stroke of acute coronary syndrome (ACS). Patients assigned to PCI were at higher operative risk than patients scheduled for CABG (6.49 ± 4.09 vs. 4.81 ± 2.67, p=0.0032). Comparison of the group that received DESs with the CABG group did not reveal any differences in major adverse cardio-cerebral events (MACCE) occurrence (21% vs. 16%, p=NS). Patients in the CABG and PCI groups died with similar frequency (11% vs. 16%, p=NS). The mortality rate in the CABG group was higher than among those treated with DES (11% vs. 3%, p=0.049). The rate of ACS was higher in the PCI group than in the CABG group (13% vs. 4%, p=0.016). Despite the fact that patients treated with PCI were at higher operative risk, PCI with DES was shown to be comparable to CABG in terms of mortality, stroke and ACS. However, the frequency of repeat revascularizations remains a constant concern with PCI.
    Full-text · Article · Jan 2012 · Yonsei medical journal
  • Source
    • "Coronary stenting, particularly the introduction of drug-eluting stents has been increasingly used to treat coronary artery disease [19] [20] [21]. The relatively low rates of in-stent restenosis have enabled the coronary stenting as an effective alternative to angioplasty with stenting of the left main coronary artery [22]. The description of the progression of atherosclerosis in the left coronary artery and at the bifurcation is therefore of paramount importance in the planning of stent deployment so that precise information about the type of stent to be used can be provided to ensure the success rate. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the relationship between left coronary bifurcation and dimensional changes and development of coronary artery disease using multislice CT angiography. 30 patients (18 men, 12 women, mean age, 56 years ± 8) suspected of coronary artery disease undergoing 64- and 256-slice CT angiography were included in the study. Left bifurcation angle and left coronary diameter were measured to determine the relationship between angulation and plaque formation and subsequent dimensional changes. Plaques were present in the left coronary artery in 22 patients with variable angulations and dimensional changes. The mean bifurcation angle between left anterior descending and left circumflex arteries was measured 89.1° ± 13.1° (range, 55.3°, 134.5°) among all patients. The mean bifurcation angle measured in patients with normal and diseased left coronary artery was 75.5° ± 19.8° (range, 60°, 96.1°), and 94° ± 19.7° (range, 55.3°, 134.5°), respectively, with significant difference between these two groups (p=0.02). Similarly, there is a significant difference in the mean diameters of left anterior descending and left circumflex between patients with normal and diseased left coronary artery (p<0.001), which were measured 2.8 ± 0.3mm (range, 2.2, 3.2mm) and 2.1 ± 0.4mm (range, 1.9, 2.9 mm) for the normal left coronary arteries, 4.0 ± 0.8mm (range, 2.5, 6.1mm) and 2.9 ± 0.5mm (range, 1.6, 3.9 mm) for the diseased left coronary arteries, respectively. There is a direct correlation between left bifurcation angle and dimensional changes and formation of plaques. Multislice CT angiography can be used to provide relevant features of left coronary atherosclerosis.
    Full-text · Article · May 2011 · European journal of radiology
  • Source
    • "Bifurcation LMCA lesions were, however, considered inappropriate for PCI due to technical difficulties in stent implantation and relative higher rates of restenosis. Valgimigli et al (2005) 9 reported short and long term outcome after DES implantation for PCI of ULMCA from Rotterdam (Netherlands), Cardiology Hospital Registries (Research and T ăSearch). From April 2001 to Dec. 2003, 181 patients underwent PCI for LMCA. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Coronary artery bypass surgery (CABG) is the treatment of choice in unprotected left main coronary artery disease (ULMCA). However drug eluting stent (DES) implantations in ULMCA have ushered a revolution in the field of percutaneous coronary interventions (PCI) for left main coronary artery (LMCA) by reducing peri-procedural mortality and incidence of major adverse cardiac events (MACE). More randomized trials and follow-up studies are required before PCI with DES can be chosen as alternative to CABG.
    Preview · Article · May 2007 · The Journal of the Association of Physicians of India
Show more