on October 26, 2009
Published online before print October 26, 2009, doi: 10.1161/CIRCULATIONAHA.109.873349
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Submitted on April 27, 2009
From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai Hospital (Y.Y.), Kishiwada, Japan; Nanpuh Hospital (S. Toyoshima), Kagoshima, Japan; National Hospital Organization Kagoshima Medical Center (H.N.), Kagoshima, Japan; Osaka City General Hospital (K.H.), Osaka, Japan; Osaka Red Cross Hospital (M. Tanaka), Osaka, Japan; Saiseikai Noe Hospital (S. Take), Osaka, Japan; Shonan Kamakura General Hospital (S.S.), Kamakura, Japan; Teikyo University Hospital (T.I.), Tokyo, Japan; and Kurashiki Central Hospital (K.M.), Kurashiki, Japan. * To whom correspondence should be addressed. E-mail: taketaka{at}kuhp.kyoto-u.ac.jp.
Background—Long-term outcomes after stenting of an unprotected left main coronary artery (ULMCA) with drug-eluting stents have not been addressed adequately despite the growing popularity of this procedure. Methods and Results—j-Cypher is a multicenter prospective registry of consecutive patients undergoing sirolimus-eluting stent implantation in Japan. Among 12 824 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 3 years was significantly higher in patients with ULMCA stenting (n=582) than in patients without ULMCA stenting (n=12 242; 14.6% versus 9.2%, respectively; P<0.0001); however, there was no significant difference between the 2 groups in the adjusted risk of death (hazard ratio 1.23, 95% confidence interval 0.95 to 1.60, P=0.12). Among 476 patients whose ULMCA lesions were treated exclusively with a sirolimus-eluting stent, patients with ostial/shaft lesions (n=96) compared with those with bifurcation lesions (n=380) had a significantly lower rate of target-lesion revascularization for the ULMCA lesions (3.6% versus 17.1%, P=0.005), with similar cardiac death rates at 3 years (9.8% versus 7.6%, P=0.41). Among patients with bifurcation lesions, patients with stenting of both the main and side branches (n=119) had significantly higher rates of cardiac death (12.2% versus 5.5%; P=0.02) and target-lesion revascularization (30.9% versus 11.1%; P<0.0001) than those with main-branch stenting alone (n=261). Conclusions—The higher unadjusted mortality rate of patients undergoing ULMCA stenting with a sirolimus-eluting stent did not appear to be related to ULMCA treatment itself but rather to the patients' high-risk profile. Although long-term outcomes in patients with ostial/shaft ULMCA lesions were favorable, outcomes in patients with bifurcation lesions treated with stenting of both the main and side branches appeared unacceptable.
Accepted on September 1, 2009
Three-Year Outcomes After Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease. Insights From the j-Cypher Registry
Mamoru Toyofuku MD,
Key words: stents • revascularization • coronary disease • ischemia • restenosis
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