Abstract
Recent publications have demonstrated superior outcomes in unprotected left main patients after paclitaxel-eluting stent (PES) implantation. Long-term data in these patients are limited. The aim of this study was to evaluate if intravascular ultrasound (IVUS)-guided PES implantation is superior to bare metal stent (BMS) implantation in unprotected left main disease after lesion pretreatment with cutting balloon during long-term follow-up. Unprotected left main patients were randomized to BMS (n=50) or PES implantation (n=53). All interventions were IVUS-guided and cutting balloon pretreatment before stenting was performed in all patients. All patients were scheduled for 6-month and 3-year follow-up. Subgroups of patients who underwend IVUS and OCT imaging at 3-year follow-up were analyzed. The primary endpoint was the major adverse cardiac events (MACEs) defined as death, Q-wave myocardial infarction, or target lesion revascularization. Baseline characteristics were similar in both the groups with a mean SYNTAX score of 31.4±14.5 in BMS and 32.6±11.7 in PES patients (P=0.718). At 3 years, MACEs occurred in 18 patients (36.0%) in the BMS and 7 patients (13.2%) in the PES group (P=0.011). By IVUS, percent neointimal volume obstruction at 3 years was reduced from 18.1%±8.7% with BMSs to 10.0%±5.4% with PESs (P<0.001). The total number of uncovered stent struts per OCT image and IVUS image was 0.4±0.8 and 1.2±1.5, respectively (P<0.001). The current study demonstrated that IVUS-guided PES implantation was superior to BMS implantation after cutting balloon pretreatment in unprotected left main disease at 3 years. If compared with IVUS, OCT was more precise in the assessment of stent endothelization.
Highlights
Coronary artery bypass grafting (CABG) is the gold standard for the treatment of unprotected left main coronary artery (ULMCA) disease [1], many patients are scheduled for percutaneous coronary intervention (PCI)
At 3 years, major adverse cardiac events (MACEs) occurred in 18 patients (36.0%) in the Baremetal stents (BMS) and 7 patients (13.2%) in the paclitaxel-eluting stent (PES) group (P=0.011)
The current study demonstrated that intravascular ultrasound (IVUS)-guided PES implantation was superior to BMS implantation after cutting balloon pretreatment in unprotected left main disease at 3 years
Summary
Coronary artery bypass grafting (CABG) is the gold standard for the treatment of unprotected left main coronary artery (ULMCA) disease [1], many patients are scheduled for percutaneous coronary intervention (PCI). Initial studies on balloon angioplasty for ULMCA disease reported poor short- and long-term results [2, 3]. Recent progress in interventional cardiology, including the use of drug-eluting stents (DESs), intravascular ultrasound (IVUS) imaging, debulking before stenting, and effective antiplatelet agents, have resulted in the decreased restenosis rate [8, 9]. Several recent publications have demonstrated superior short- and mid-term outcomes in patients with left main artery disease after DES versus BMS implantation [10, 11] and similar survival rates after. Some reports have raised concern about incomplete or delayed neointimal coverage of DES with a subsequent increase in late stent thrombosis [23]
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