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The aim of this registry is to demonstrate whether theimplantation of a Zotarolimus-eluting (ZES) Endeavor™ stent (Medtronic Corp., USA.) into an unprotected left main stem is both safe and efficiently feasible in the long term, in an unselected patient population with significant co-morbidities.
Between February 2006 and February 2010, all patients of our department (no on-site cardiac surgery, 24 hours on-call service) who underwent stenting of an unprotected left main stem received an Endeavor™-Stent. Treatment of concomitant lesions was left to the investigators discretion. All patients were included into a registry containing both clinical and interventional data. During follow-up patients were contacted with a written questionnaire. If necessary, the information was supplemented by telephone contact with the patients or their treating physicians. Primary endpoints included death, myocardial infarction (MI) or repeated target lesion revascularization (TLR) and the combination of events (MACE).
A total of 58 patients were included (42 men, 16 women, median age 72.3 years). 24% of all the patients had diabetes mellitus. In 53% of the patients, the intervention took place due to angina or proven stress ischemia, in 34% due to a MI within 72 hours, in 12% due to a myocardial infarction more than 72 hours before. Twelve percent had a severely reduced left ventricular ejection fraction (<30%), and 4 patients (7%) were in cardiogenic shock. The median logistic EuroScore was 4.4%; the SYNTAX Score 22.0. Seventy-four percent of the lesions were bifurcation lesions. In 53% of cases there was no intervention of other lesion during the index procedure, in 21% only with Endeavor™ stents, in 16% only with bare metal stents (BMS), in 10% both with Endeavor™ stents and BMS. The median follow-up time was 34.7 months. After 12, 24 and 36 months, total mortality was 14, 17 and 22%; cardiac mortality was 2, 4 and 9%; the TLR rate was 6, 6 and 8%; and the MACE rate was 21, 24, 30 and 33%. Seventy-one percent of all patients had dual antiplatelet therapy up to 6 months after the procedure. Confirmed stent thrombosis occurred in only one case during the follow-up period.
As our registry represents all-comers data, the long-term results concerning the safety and efficiency of the Endeavor™ stent in the unprotected main stem of the left coronary artery appeared acceptable.
- 2013 American College of Cardiology Foundation