Unprotected left main stenting in the real world: five-year outcomes of the French Left Main Taxus registry

作者：Mylotte Darren^*; Meftout Brahim; Moynagh Anouska; Vaquerizo Beatriz; Darremont Olivier; Silvestri Marc; Louvard Yves; Leymarie Jean Louis; Morice Marie Claude; Lefevre Thierry; Garot Philippe

来源：Eurointervention, 2012, 8(8): 970-981.

DOI：10.4244/EIJV8I8A147

• percutaneous coronary intervention
• left main
• stent
• coronary artery bypass grafting
• bifurcation
• coronary artery disease

Aims: Limited long-term data are available to support drug-eluting stent (DES) unprotected left main (LM) intervention. We sought to evaluate long-term outcomes of LM intervention with paclitaxel-eluting stents.
Methods and results: In this prospective multicentre registry, 291 patients with unprotected LM stenosis underwent percutaneous revascularisation with the TAXUS (R) Express (R) stent, using a consistent technical approach for both ostial/shaft and bifurcation lesions (provisional side branch stenting). At five years (n=263), the cumulative incidence of major adverse cardiac events (MACE) and cardiac death were 23.6% and 12.5%, respectively. Myocardial infarction (MI) occurred in 16 patients (6.1%), definite stent thrombosis in 0.4%, and target lesion revascularisation (TLR) was required in 10.3%. Patients with distal LM lesions requiring two-stent procedures had increased MACE compared with those with single-stent interventions (34.1% vs. 17.8%, p=0.009). This was primarily driven by an increased incidence of cardiac death (18.2% vs. 8.5%, p=0.05). Diabetes was associated with increased TLR and was an independent predictor of MACE at five years (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.10-3.99, p=0.02).
Conclusions: This study confirms the long-term safety and efficacy of the TAXUS (R) DES in unprotected LM stenting. Diabetes and the need for a second stent in distal LM interventions were associated with an increased risk of adverse outcomes.

• 出版日期2012-12