Early and mid-term results of drug-eluting stent implantation in unprotected left main

Background - The safety and efficacy of percutaneous coronary intervention in unprotected left main (ULM) coronary arteries are still a matter of debate. Methods and Results - All consecutive patients who had a sirolimus-eluting stent ( Cypher, Cordis, Johnson and Johnson Co) or a paclitaxel-eluting stent ( Taxus, Boston Scientific) electively implanted in de novo lesions on unprotected left main were analyzed. Patients treated with a drug-eluting stent ( DES) were compared with the historical group of consecutive patients treated with bare metal stent (BMS). Eighty-five patients were treated with DES; 64 had BMS implantation. Patients treated with DES had lower ejection fractions (51.1 +/- 11% versus 57.4 +/- 13%, P = 0.002) and were more often diabetics (21.2% versus 10.9%, P = 0.12) with more frequent distal left main involvement (81.2% versus 57.8%, P = 0.003). Furthermore, in the DES group, smaller vessels (3.33 +/- 0.6 versus 3.7 +/- 0.7 mm, respectively; P = 0.0001) with more lesions (2.94 +/- 1.6 versus 2.25 +/- 1.3, P = 0.004) and vessels ( 2.03 +/- 0.69 versus 1.8 +/- 0.72, P = 0.05) were treated with longer stents ( 24.3 +/- 12 versus 15.8 +/- 8.6 mm, P = 0.0001). Despite the higher-risk patients and lesion profiles in the DES group, the incidence of major cardiac events at a 6-month clinical follow-up was lower in the DES than in the BMS group (20.0% versus 35.9%, respectively; P = 0.039). Moreover, cardiac deaths occurred in 3 DES patients (3.5%), as compared with 6 (9.3%) in the BMS group ( P = 0.17). Conclusions - In this early experience with DES in unprotected left main, this procedure appears safe with favorable and improved clinical results as compared with historical control subjects with a BMS. A randomized study comparing surgery appears justified at present.