Abstract 18068: Everolimus- versus Sirolimus-Eluting Stents for the Treatment of Patients with Unprotected Left Main Coronary Artery Disease (Results from EXCELLENT Registry)

Abstract

Background: Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has become a reasonable alternative to coronary artery bypass graft in the treatment of unprotected left main coronary artery disease. However, the results of 2 nd generation DES in the treatment of these lesions are unknown. The objective of this study was to compare the efficacy and safety of stenting with everolimus-eluting stent (EES) compared with sirolimus-eluting stent (SES) for the treatment of left main disease in the “real world” setting. Methods: In the Efficacy of Xience/promus versus Cypher in rEducing Late Loss after stENTing (EXCELLENT) registry, a total of 5161 patients were enrolled from 29 centers in Korea between January 2006 and May 2010. Of these, 241 patients with symptomatic left main coronary artery disease undergoing PCI were analyzed; 139 patient implanted with EES and 102 with SES. We evaluated the rate of all-cause death, cardiac death, myocardial infarction, ischemia-driven target lesion revascularization (TLR) and stent thrombosis. The primary end point of this study was major adverse cardiac events (MACE, composite of death, myocardial infarction, and ischemia-driven TLR) at 1 year. Results: Baseline characteristics are similar between the two groups. At 1 year, the cumulative incidence of MACE was 8.6% in the EES and 10.8% in the SES group (p = 0.697). There were no differences in the rate of hard end point (death and myocardial infarction) (5.0% vs. 4.9%, p = 0.909) between the two groups. However, the rate of TLR was numerically lower in the EES group compared with the SES group (3.6% vs. 5.9%), although statically insignificant (p = 0.470). One patient in the EES group (0.7%) and one patient in the SES group (1.0%) experienced stent thrombosis (p = 0.823). Conclusion: Implantation of either EES or SES for the treatment of unprotected left main disease is effective and safe. Both stents showed comparable 1-year clinical results regarding MACE and hard endpoint.