Author + information
- Received May 14, 2013
- Revision received August 16, 2013
- Accepted August 30, 2013
- Published online January 1, 2014.
- Klaus Tiroch, MD∗∗ (, )
- Julinda Mehilli, MD†,‡,
- Robert A. Byrne, MB§,
- Stefanie Schulz, MD§,
- Steffen Massberg, MD†,‡,
- Karl-Ludwig Laugwitz, MD‡,‖,
- Marc Vorpahl, MD∗,
- Melchior Seyfarth, MD∗,
- Adnan Kastrati, MD‡,§,
- ISAR-LEFT MAIN Study Investigators
- ∗Department of Cardiology, Helios Klinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany
- †Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilian Universität, Munich, Germany
- ‡Department of Cardiology, DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- §Department of Cardiology, Deutsches Herzzentrum, Technische Universitat, Munich, Germany
- ‖1. Department of Cardiology, Medizinisches Klinik Rechts der Isar, Technische Universitat, Munich, Germany
- ↵∗Reprint requests and correspondence:
Privatdozent Dr. Klaus Tiroch, Helios Klinikum Wuppertal, 3. Medizinische Klinik - Kardiologie, Arrenberger Strasse 20, 42117 Wuppertal, Germany.
Objectives This study sought to evaluate the impact of anatomic and procedural variables on the outcome of the unprotected left main coronary artery (uLMCA) itself after drug-eluting stent (DES) implantation.
Background There is a controversial debate regarding when and how to perform percutaneous coronary intervention (PCI) for an uLMCA stenosis.
Methods This analysis is based on a randomized study of 607 patients undergoing PCI for uLMCA, randomized 1:1 to receive paclitaxel- or sirolimus-eluting stents. We evaluated the impact of the SYNTAX score, uLMCA anatomy, and stenting technique on in-stent restenosis (ISR), target lesion revascularization (TLR), and the 3-year outcomes.
Results The 3-year cardiac mortality rate was 5.8%; 235 (39%) patients had a true bifurcation lesion (TBL), and the median SYNTAX score was 27. TBL was associated with a higher need for multiple stents (72% vs. 37%, p < 0.001). TBL was a significant predictor of ISR (23% vs. 14%, p = 0.008) and for TLR (18% vs. 9%, p < 0.001). The need for multiple stents was a predictor of ISR (22% vs. 13%, p = 0.005) and for TLR (16% vs. 9%, p = 0.005). Culotte stenting showed better results compared with T-stenting for ISR (21% vs. 56%, p = 0.02) and for TLR (15% vs. 56%, p < 0.001). We observed a significant association between uLMCA-TLR and SYNTAX scores (9.2% for scores ≤22, 14.9% for scores 23 to 32, and 13.0% for scores ≥33, p = 0.008).
Conclusions PCI of uLMCA lesions with DES is safe and effective out to 3 years. TBL and multiple stents were independent predictors for ISR. In the multivariate analysis, independent predictors for TLR were TBL, age, and EuroSCORE (European System for Cardiac Operative Risk Evaluation). (Drug-Eluting-Stents for Unprotected Left Main Stem Disease [ISAR-LEFT-MAIN]; NCT00133237)
The ISAR-LEFT MAIN study was supported in part by an unrestricted grant from Cordis. Dr. Mehilli has received lecture fees from Abbott Vascular, Biotronik, Cordis, Eli Lilly and Company/Daiichi Sankyo, Terumo, and The Medicines Company. Dr. Kastrati has received lecture fees from Abbott, AstraZeneca, Biosensors, Biotronik, Bristol-Myers Squibb, Merck, The Medicines Company, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 14, 2013.
- Revision received August 16, 2013.
- Accepted August 30, 2013.
- American College of Cardiology Foundation