Long-term clinical outcomes after sirolimus-eluting stent implantation for unprotected left main coronary artery disease
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ORIGINAL ARTICLE
Long-term clinical outcomes after sirolimus-eluting stent implantation for unprotected left main coronary artery disease Hirooki Higami • Hiroki Shiomi • Shunichiro Niki • Junichi Tazaki • Masao Imai • Naritatsu Saito • Takeru Makiyama • Satoshi Shizuta • Tetsuo Shioi • Koh Ono • Takeshi Kimura
Received: 19 February 2014 / Accepted: 22 August 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract Previous studies reporting long-term (C5 year) clinical outcome in patients with unprotected left main coronary artery (LMCA) disease undergoing drug-eluting stent (DES) implantation are currently limited, although late adverse events beyond 1 year are one of the major concerns of DES. We evaluated long-term clinical outcomes in 134 consecutive patients who underwent sirolimus-eluting stents (SES) for unprotected LMCA lesion in a single center from 2004 to 2009. The median follow-up duration was 3.8 (range: 0.5–7.9) years. Eight patients suffered from serious cardiovascular events potentially related to LMCA lesion (primary outcome measure) (sudden cardiac death: N = 5, emergent coronary revascularization for the LMCA lesion: N = 2, and acute congestive heart failure related to LMCA lesion: N = 1) with the cumulative 5-year incidence of only 4.4 %. The cumulative 5-year incidence of all-cause death, cardiac death, target vessel myocardial infarction, definite stent thrombosis, and target-lesion revascularization was 26.5, 8.1, 0, 0, and 12.9 %, respectively. In a subgroup analysis, the cumulative incidence of the primary outcome measure was significantly higher in patients with 2-stenting (N = 27) than in patients with 1-stenting (N = 107) (14.0 and 2.2 %,
Electronic supplementary material The online version of this article (doi:10.1007/s12928-014-0297-x) contains supplementary material, which is available to authorized users. H. Higami H. Shiomi (&) J. Tazaki M. Imai N. Saito T. Makiyama S. Shizuta T. Shioi K. Ono T. Kimura Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan e-mail: [email protected] S. Niki Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical center, Kyoto, Japan
P \ 0.001). All 8 patients with serious adverse events had a true bifurcation lesion and 5 patients received 2-stenting for the LMCA lesion. SES implantation in patients with unprotected LMCA lesion was associated with a favorable longterm outcome with acceptably low rate of serious adverse event potentially related to LMCA lesion. However, complex LMCA lesions necessitating 2-stenting strategy might be associated with higher risk for serious adverse events. Keywords Left main coronary artery disease Coronary stent Percutaneous coronary intervention Coronary bifurcation Prognosis
Introduction Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease has become more popular in daily clinical pra
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