Lower MACE Rate Research Articles

Safety and Efficacy Outcomes of Overlapping Second-Generation Everolimus-Eluting Stents Versus First-Generation Drug-Eluting Stents

The safety and efficacy outcomes of stent overlap with second-generation drug-eluting stents (DES) have not been well established. This study aimed to compare the 1-year clinical outcomes of overlapping everolimus-eluting stents (EES) with those of overlapping first-generation DES. This retrospective analysis included 350 patients treated with overlapping EES (169 patients with 237 lesions), sirolimus-eluting stents (SES, 102 patients with 252 lesions), or paclitaxel-eluting stents (PES, 79 patients with 182 lesions). End points were major adverse cardiovascular events (MACE: defined as the composite of death, myocardial infarction, or target lesion revascularization), target vessel revascularization, and definite stent thrombosis at 1 year. During a follow-up of 1 year, overall MACE occurred in 6.5% of EES-, 16.8% of SES-, and 10.1% of PES-treated patients (p= 0.026). Myocardial infarction was lowest in the EES group versus SES and PES groups (0 vs 1.0% vs 2.5%, respectively; p= 0.080), and mortality was similar (3.6% vs 9.0% vs 5.1%, p= 0.162). The EES patients showed a trend toward lower rates of 1-year target lesion revascularization (3.1% vs 8.2% vs 6.5%, p= 0.181) and target vessel revascularization (3.7% vs 9.1% vs 11.7%, p= 0.051) compared with the SES- and PES-treated patients. The cumulative incidence of definite stent thrombosis was lowest in the EES group (0 for EES vs 3.9% for SES vs 2.5% for PES, p= 0.014). In conclusion, stent overlap with EES versus first-generation DES was associated with lower rates of MACE and stent thrombosis. Our results suggest that the use of EES when deploying overlapping stents is effective and safe.

Synergistic effect of thrombus aspiration and abciximab in primary percutaneous coronary intervention

Previous studies failed to assess the individual prognostic role of thrombus aspiration (TA) or abciximab in primary percutaneous coronary intervention (pPCI), due their prevalent combined use. A total of 644 consecutive ST-segment elevation myocardial infarction patients treated with pPCI were included in this retrospective registry from January 2006 to December 2008. Patients were divided in: (a) Group 1, with conventional pPCI; (b) Group 2, with pPCI and abciximab; (c) Group 3, with pPCI and TA; (d) Group 4, with pPCI and abciximab plus TA. Primary end point was the composite of major adverse cardiovascular events (MACEs, defined as overall mortality, myocardial infarction, target vessel revascularization, and major bleedings) at 1 year. Baseline clinical and angiographic characteristics were not different among the groups, with the exception of a younger age in group 4. The two groups of patients treated with TA (group 3 and 4) received more frequently direct stenting (P < 0.001 vs. group 1 for both), presented higher rate of end-procedural TIMI flow grade 3 (P < 0.001 vs. group 1 for both), and lower rate of no-reflow (P = 0.016 and P < 0.001 vs. group 1, respectively). Patients of group 2 presented a borderline nonsignificant trend toward higher rate of end-procedural TIMI flow grade 3 (P = 0.083 vs. group 1). MACEs at 1 year were 43 (29%) in group 1 versus 25 (22%) in group 2 versus 24 (19%) in group 3 versus 32 (13%) in group 4 (log-rank P = 0.001). At the multivariate Cox regression analysis, combined TA plus abciximab in group 4 [hazard ratio (HR): 0.48, confidence interval (CI) 95% 0.28-0.84, P = 0.01] and a higher left ventricular ejection fraction (HR: 0.97, CI 95% 0.95-0.98, P < 0.001) were significantly associated with lower MACE rate. The combination of pharmacologic and mechanic antithrombotic treatment during pPCI was associated with better 1-year clinical outcome.

Lower MACE Rate with Shorter Pain to Balloon Times for Ambulance Activated PPCI

deficit according to the standardised international Valve Academic Research Consortium (VARC) definitions. Results: Baseline characteristics included: 50% males, average age 84± 5 years, 84% NYHA III/IV, STS score 5.3± 3.8, logEuroSCORE 16± 9.4, history of atrial fibrillation 24% and LVEF 60± 11%. Procedural success was 98.7% and major vascular complications occurred in 4% of patients. Thirty-day survival was 98.7%. There were no peri-procedural strokes. One patient (0.6%), a 92-year-old woman, suffered a stroke three weeks after TAVI. Ninetyfour percent of patients improved ≥1 NYHA class. Aortic valve area significantly improved to 2.0± 0.6 cm2 withfinal mean gradient 10± 3.6mmHg. The majority (84%) had trivial/mild AR. Permanent pacemakers were inserted in 28% of patients. Conclusions: In this two centre Australian experience of TAVI in high-risk patients with symptomatic aortic stenosis, excellent procedural success rates were achieved with a very low rate of stroke and other major complications. http://dx.doi.org/10.1016/j.hlc.2013.05.340 339 Lower Incidence of Stent Thrombosis andMace with Prasugrel in Stemi Patients <76 Years of Age R. Samanta ∗, A. Rehmani, J. Chandrasekhar, D. McGill, C. Allada, M. Rahman, A. Farshid, S. O’Connor, R. Tan The Canberra Hospital, Australia Background:Despite the use of Clopidogrel and aspirin in STEMI patients, the risk of acute ischaemic complications remains significant. Aim: To compare the incidence of MACE (Death, AMI, CVA and TVR) with Prasugrel vs. Clopidogrel in STEMI patients <76 years undergoing PCI at our institution. Methods:We retrospectively analysed the PCI database at The Canberra Hospital for all STEMI patients <76 years undergoing PCI between 2008 and 2012. Clopidogrel Prasugrel p Male Gender 81.3% 89.4% 0.02 Diabetes 17.4% 17.7% 0.0005 2b3a Use 65% 37.5% 0.0001 Stent Throm. 2% 0% 0.026 Death 4.5% 2.1% 0.18

038 Drug eluting stent implantation is associated with lower mace rates than bare metal stent implantation in primary PCI for ST elevation myocardial infarction

IntroductionDrug-eluting stent (DES) implantation during the treatment of ST-elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PCI) is controversial due to concerns regarding increased risk of stent thrombosis. We...

A prospective multicentre registry, evaluating real-world usage of the Tryton side branch stent: results of the E-Tryton 150/Benelux registry

The percutaneous treatment of coronary bifurcation lesions remains hampered by suboptimal results, mainly in the side branch (SB), even with the use of drug-eluting stents. Dedicated bifurcation stents could provide an attractive alternative to improve early outcomes and reduce SB restenosis. We aimed to assess in a prospective single-arm multicentre registry, safety and effectiveness at 6-month clinical follow-up of the Tryton dedicated side branch (SB) stent. In this prospective international registry, patients with coronary bifurcation lesions underwent treatment with a dedicated stenting technique using the Tryton stent, in conjunction with a "workhorse" main branch (MB) stent (drug-eluting or bare metal). The Tryton stent is specifically designed for bifurcations, with minimal strut/vessel ratio in the proximal MB, providing full strut coverage at the SB ostium, with short stent length in the SB and with the ability to adapt to the wide spectrum of bifurcation angles and sizes. The primary endpoint was 6-month major adverse cardiac events (MACE: cardiac death, myocardial infarction and target lesion revascularisation). Secondary endpoints were technical and procedural success (respectively defined as successful implantation of Tryton at the intended lesion and successful performance of the whole procedure with Tryton without in-hospital MACE). A total of 302 patients were enrolled. Of these, 296 had 6-month data available for evaluation. Technical and procedural success occurred in 98.0% (95% confidence interval: 95.7%-99.1%) and 94.4% (91.2%-96.5%) patients, respectively. The cumulative 6-month MACE rate was 6.4% (4.2%-9.7%), including 4.7% (2.9%-7.7%) myocardial infarctions (3.7% periprocedural), and 3.4% (2.0%-6.1%) target lesion revascularisations (2.4% in the MB, 0.7% in the SB, and 0.3% in both MB and SB). One stent thrombosis (0.3% [0%-1.6%]) occurred. The treatment of bifurcation lesions with a dedicated Tryton stent is safe and feasible, with good technical and procedural success, very low revascularisation, MACE and stent thrombosis rates at 6-month clinical follow-up.

Lower MACE Rates with Integrity™ Stents Compared to Contemporary Bare Metal Stents in High Risk PCI Cohort

Lower MACE Rates with Integrity™ Stents Compared to Contemporary Bare Metal Stents in High Risk PCI Cohort

Four-year clinical follow-up of the ABSORB everolimus-eluting bioresorbable vascular scaffold in patients with de novo coronary artery disease: the ABSORB trial

The first-in-man ABSORB Cohort A trial demonstrated the bioresorption of the ABSORB BVS (Abbott Vascular, Santa Clara, CA, USA) at two years. This report describes the 4-year clinical outcomes. The ABSORB Cohort A trial enrolled 30 patients with a single de novo native coronary artery lesion. Clinical follow-up was available in 29 patients since one patient withdrew consent after the six month follow-up. At four years, the hierarchical ID-MACE of 3.4% remained unchanged. Clopidogrel therapy had been discontinued in all patients. Four-year clinical results demonstrate a sustained low MACE rate (3.4%) without any late complications such as stent thrombosis.

The Valentines Trial: results of the first one week worldwide multicentre enrolment trial, evaluating the real world usage of the second generation DIOR paclitaxel drug-eluting balloon for in-stent restenosis treatment

To assess the safety and efficacy of the second generation DIOR paclitaxel drug-eluting balloon (DEB) for in-stent restenosis in a real world setting in a prospective single-arm registry with 8-month clinical outcomes. In this "real world", international prospective registry, patients with in-stent restenosis (bare-metal stent and drug-eluting stent) were enrolled- in a unique study design- with a one week enrolment period, spread over 104 centres worldwide. Patients underwent predilatation with a regular balloon, with subsequent DEB inflation in the target lesion. Additional stenting of the target lesion was left to the operators discretion in case of suboptimal angiographic success (TIMI flow <3 and/or residual stenosis >30%). The primary endpoint was 6-9-month major adverse cardiac events (MACE: all cause death, myocardial infarction, and target vessel revascularisation). A total of 250 evaluable patients were enrolled in a large web-based clinical research form and treated with the second generation DIOR DEB. Of these, 244 had 6-9 month clinical follow-up, with a mean follow-up time of 7.5 months. The cumulative MACE rate at follow-up was 11.1%, with 3 (1.2%) cardiac deaths, 1 (0.4%) non-cardiac death, 5 (2.0%) myocardial infarctions of which 2 (0.8%) periprocedural, 21 (8.6%) target vessel revascularisations, of which 18 (7.4%) target lesion revascularisations. In-stent restenosis treatment with the second generation DIOR DEB is safe and feasible, with high angiographic success and low target lesion revascularisation and overall MACE rates. Moreover this new and unique method of high speed and short duration multicentre study enrolment was very successful.

Improved Outcome Prediction by SPECT Myocardial Perfusion Imaging After CT Attenuation Correction

The aim of this study was to determine the impact of attenuation correction with CT (CT-AC) on the prognostic value of SPECT myocardial perfusion imaging (SPECT MPI). The summed stress score (SSS; 20-segment model) was obtained from filtered backprojection (FBP) and iterative reconstruction with CT-AC in 876 consecutive patients undergoing a 1-d stress-rest (99m)Tc-tetrofosmin SPECT MPI study for the evaluation of known or suspected coronary artery disease. Survival free of major adverse cardiac events (MACEs; cardiac death or nonfatal myocardial infarction) and survival free of any adverse cardiac events (including cardiac hospitalization, unstable angina, and late coronary revascularization) were analyzed by Kaplan-Meier analysis. At a mean follow-up of 2.3 ± 0.6 y, a total of 184 adverse events occurred in 145 patients, including 35 MACEs (16 cardiac deaths [rate, 1.8%] and 19 nonfatal myocardial infarctions [rate, 2.2%]). With FBP, an SSS of 0-3 best distinguished patients with a low MACE rate (0.6%), followed by an SSS of 4-8 (4.3%), with increased MACE rate, and an SSS of 9-13 (3.8%), which was comparable. By contrast, with CT-AC the discrimination of low from intermediate MACE rate was best observed between an SSS of 0 (0%) and an SSS of 1-3 (3.7%), with a plateau at an SSS of 4-8 (3.2%). CT-AC for SPECT MPI allows improved risk stratification. The prognostically relevant SSS cutoff is shifted toward lower values.

Three-year results of clinical follow-up after a bioresorbable everolimus-eluting scaffold in patients with de novo coronary artery disease: the ABSORB trial

Multimodality imaging of the first-in-man trial using a fully resorbable everolimus-eluting scaffold (BVS, Abbott Vascular, Santa Clara, CA, USA) demonstrated at two years the bioresorption of the device while preventing restenosis. Nevertheless, the long-term safety and efficacy of this novel therapy remain to be documented. The ABSORB trial completed in July 2006 at four clinical sites in Europe and New Zealand the enrolment of 30 patients with a single de novo native coronary artery lesion. The major clinical endpoint was ischaemia-driven major adverse cardiac events (ID-MACE) defined as a composite of cardiac death, myocardial infarction, or ischaemia-driven target lesion revascularisation. Clinical follow-up was available in 29 patients since one patient withdrew consent. At 46 days, one patient experienced a single episode of chest pain and underwent a diagnostic optical coherence tomography and subsequently a target lesion revascularisation with slight troponin rise after the procedure. At 3-year the hierarchical ID-MACE of 3.4% remained unchanged. Clopidogrel therapy was discontinued in all but one patient. There has been no stent thrombosis reported. Two non-cardiac deaths were reported; one from duodenal perforation, the other from Hodgkin disease. Two patients underwent non-ischaemia driven target vessel revascularisation. Three-year clinical results have demonstrated a sustained low MACE rate (3.4%) without any late complication such as stent thrombosis.

TCT-425: Direct Transfer to a Cardiac Centre Results In Lower MACE Rates Compared to Inter-Hospital Transfers for Primary PCI

TCT-425: Direct Transfer to a Cardiac Centre Results In Lower MACE Rates Compared to Inter-Hospital Transfers for Primary PCI

Evaluation of the effects of everolimus‐eluting and paclitaxel‐eluting stents on target lesions with jailed side branches: 2‐year results from the SPIRIT III randomized trial

To evaluate whether an everolimus-eluting stent (EES) with thinner stent struts and polymer results in less periprocedural myonecrosis and adverse outcomes. Higher periprocedural myocardial infarction (MI) rates have been reported with the TAXUS® EXPRESS(2) paclitaxel-eluting stent (PES) compared to the bare metal EXPRESS(2)® stent due to more frequent side branch compromise, presumably attributable to the thickness of the stent/polymer on the PES. In the SPIRIT III trial, we identified 113 patients in the XIENCE V® EES group and 63 patients in the TAXUS EXPRESS(2) PES group who met the criteria of having a lesion with a jailed side branch (<2 mm diameter, and <50% stenosis). Two-year clinical outcomes were evaluated. A periprocedural increase in Creatine Kinase-MB >1× upper normal level occurred in 9.0% of EES compared to 29.7% of PES patients with jailed side branches, P = 0.01. Through 2 years, major adverse cardiac events (MACE; cardiac death, MI, or target lesion revascularization [TLR]) occurred in 6.8% of EES and 19.0% of PES jailed side branch patients (P = 0.03), with numerically lower rates of MI (2.9% vs. 10.3%, P = 0.07) and TLR (3.9% vs. 10.3%, P = 0.17) in the EES group, with comparable rates of cardiac death (1.9% vs. 1.7%, P = 1.00). In this post-hoc analysis of the SPIRIT III RCT, patients undergoing stenting of target lesions with jailed side branches with the thin strut and polymer XIENCE V EES compared to the thicker strut TAXUS PES had lower rates of MACE through 2 years due to fewer MIs and TLRs. © 2010 Wiley-Liss, Inc.

Cardiovascular Event Rates in Diabetic and Nondiabetic Individuals With and Without Established Atherothrombosis (from the REduction of Atherothrombosis for Continued Health [REACH] Registry)

The objective of this study was to determine cardiovascular event rates in diabetic patients and nondiabetic subjects from the REACH Registry with established coronary artery disease, cerebrovascular disease, peripheral arterial disease, or multiple risk factors for atherothrombosis. REACH is an international, prospective, and contemporaneous cohort of patients with > or = 3 atherothrombotic risk factors only or established atherothrombotic disease, of which 30,043 have diabetes. The main outcomes after 1-year follow-up were cardiovascular death, myocardial infarction, stroke, major adverse cardiovascular events (MACEs; cardiovascular death, myocardial infarction, or stroke), and MACEs/hospitalization. The MACE rate at 1 year was positively related to the number of atherothrombotic anatomic sites in diabetic patients and nondiabetic subjects, and the rate was higher in those with (3.8%) than without (3.0%, p <0.001) diabetes. Diabetic patients with risk factors only had a lower MACE rate than nondiabetic subjects or diabetic patients with established atherothrombotic disease (2.2% vs 4.0% or 6.0%, respectively, p <0.001 for the 2 comparisons). These differences persisted after adjusting for gender and age. In conclusion, diabetic patients in the REACH Registry have an increased risk of cardiovascular events compared to nondiabetic subjects related to the number of atherothrombotic sites. Although increasing risk, diabetes may not be truly equivalent to previous atherothrombotic events on new cardiovascular event rates.

Percutaneous coronary intervention for bifurcation lesions: 2008 consensus document from the fourth meeting of the European Bifurcation Club

The bestapproach to manage a bifurcation to achieve optimal proceduraloutcomes and, more importantly, long-term success with lowrestenosis rates and low MACE rates is still heavily debated. Thisdebate has predominantly stemmed from a lack of randomiseddata, which may explain why therapeutic strategies have beenlargely based on the personal clinical experiences of highly skilledoperators practising in high-volume centres. Although the treatmentstrategy for bifurcation lesions has rapidly improved over the years,the lower procedural success, especially as the result of abrupt sidebranch (SB) closure with single stent strategies, together with therisk of thrombosis and restenosis associated with the complex twostent techniques, remains a predictor of adverse clinical outcome.The incidence of bifurcation lesions, the technical difficultiesinherent in their treatment, the lower success rate, and highercomplication and restenosis rates observed in this setting comparedwith non-bifurcation lesions have prompted intense researchactivity and have made coronary bifurcation stenting the focus ofspecific sessions in major interventional cardiology meetings.The European Bifurcation Club (EBC) was founded in 2004 in orderto devise a common terminology for the description and treatmentof bifurcation lesions and to exchange ideas on the clinical,technical, and fundamental aspects of the specific treatmentstrategies implemented in this setting. EBC meetings are heldannually. The fourth meeting was convened in Prague onSeptember 26-27, 2008, with the agenda to reach a consensus onthe current state of the art of percutaneous bifurcation treatment.The present report represents a synthesis of the findings from thismeeting, and also incorporates a literature review from the field ofbifurcation intervention. Topics covered in this consensusdocument include state-of-the-art in bifurcation stentingtechniques, discussions of the anatomical changes at carina level

Twenty‐Four‐Month Update on Double‐Kissing Crush Stenting of Bifurcation Lesions

A group of 312 patients who underwent percutaneous coronary intervention for bifurcation lesions at 12 centers in China, Singapore, Thailand, Israel, India, and Japan were enrolled in a prospective, randomized DKCRUSH-1 trial. The goal of the study was to compare the double kissing (DK) crush technique with the classical crush stenting technique. This study was carried out to determine the differences in the rates of final kissing balloon inflations (FKBI) and the long-term clinical outcomes. The 8-month results of the DKCRUSH-1 study have been previously reported. Here, we present several subgroups analysis and a 24-month clinical update. The results confirmed a sustained, lower MACE rate at 24 months with the double kissing (DK) crush stenting technique compared with that for the classical crush stenting technique (18.1% vs. 29.9%, p = 0.044).

First-in-man (FIM) study of the Stentys™ bifurcation stent – 30 days results

We report the acute and 30 day results of the OPEN I study, a multicentre prospective single arm study evaluating the safety and feasibility of the Stentys bifurcation stent. The Stentys stent is a provisional, self-expanding nitinol drug eluting or bare metal stent with small interconnections that can be disconnected by balloon angioplasty to provide access to the side-branch and full ostium coverage. Forty patients with de novo coronary bifurcation lesions were enrolled to be clinically followed-up over four years. In addition to angiographic QCA evaluation, documentary IVUS and/or OCT were used in all cases to assess the stent's deployment. The patient population consisted of 85% males with an average age of 62 years. Almost half had previous PCI, 31% previous MI and 5% previous CABG. The majority of lesions (80%) involved the LAD-D, 42% of the patients had disease affecting the side-branch, with all three arms diseased in 24% of the cases. The average lesion length in the main branch was 12.95 +/- 3.63 mm with a bifurcation angle of 55 degrees (range 30 degrees - 80 degrees). Procedural success was achieved in 39/40 cases (95.5%) due to inability to track the stent in one patient with an extremely tortuous vessel. In total 6 (15%) paclitaxel eluting and 33 (85%) BMS Stentys stents were successfully implanted, and simple disconnection of the stent mesh overlying the SB ostium was achieved in 37/39 cases (94.9%); in two cases, disconnection was not attempted. The MACE at 30 days was 5.1% as a result of one non Q-wave MI following the procedure and one ischemia-driven revascularisation six days after the procedure. This first-in-man (FIM) study demonstrates that the Stentys stent is safe and feasible resulting in an excellent procedural success rate and a low MACE rate. The struts can be easily and safely disconnected to perform provisional stenting.

Late occlusive in-stent restenosis of a bare-metal stent presenting with ST-elevation anterior MI: Is restenosis better than a late stent thrombosis?

In-stent restenosis (ISR) occurs in 20% to 40% of de novo coronary lesions treated with bare-metal stents (BMS), depending on lesion and patient-related factors. Drug-eluting stents coated with antiproliferative agents, represent a valid rationale for treatment and prevention of recurrent ISR, with low MACE rates. However, case reports and observational studies reported a definite increase in the incidence of late stent thrombosis after drug-eluting stents use, particularly in off-label cases and after clopidogrel withdrawal. The case we present shows target vessel occlusion occurring at the site of a previously implanted BMS, suggesting that in-stent restenosis was the main pathological mechanism leading to abrupt thrombotic vessel closure and acute myocardial infarction.

Prognostic Value of Normal Adenosine-Stress Cardiac Magnetic Resonance Imaging

We investigated the prognostic value of normal adenosine stress cardiac magnetic resonance (CMR) in suspected coronary artery disease (CAD). Prospectively enrolled in the study were 218 patients with suspected CAD, no stress hypoperfusion, and no delayed enhancement in CMR, and consecutively deferred coronary angiography. The primary end point was a 12-month rate of major adverse cardiac events (MACE; cardiovascular mortality, myocardial infarction, revascularization, hospitalization due to cardiovascular event). CMR indication was symptomatic angina (Canadian Cardiovascular Society II in 42% and III in 7%) or evaluation of myocardial ischemia in patients with arrhythmia, syncope, and/or equivocal stress tests and cardiovascular risk factors (51%). As the main result, the 12-month MACE rate was 2/218 (1 stent implantation, 1 bypass surgery) and CMR negative predictive value 99.1%. There was no cardiac death or myocardial infarction. In conclusion, normal adenosine stress CMR predicts a very low MACE rate and an excellent 1-year prognosis in patients with suspected CAD. Our results provide clinical reassurance that patients at risk for CAD-associated MACE were not missed by CMR. Hence, CMR may serve as a reliable noninvasive gatekeeper to reduce the number of redundant coronary angiographies.

Lower MACE rate with antibody-coated coronary stent than DES

Lower MACE rate with antibody-coated coronary stent than DES

Sirolimus-Eluting Stents vs Bare Metal Stents for the treatment of unprotected left main coronary artery stenosis.

This study compares the clinical and angiographic outcomes of sirolimus eluting stent (SES) and bare metal stent (BMS) implantation for unprotected left main coronary artery (ULMCA) stenosis. We analysed 141 unselected patients with unprotected LMCA stenosis: 72 were treated with SES and 69 with BMS. SES patients were younger, with a higher ejection fraction, had more often hypertension, family history and were more often smokers. The procedural success rate was 94.2% in SES group and 87% in BMS group. In SES group there were 2 periprocedural myocardial infarction (3%). 1 intra-procedural death (1.4%) and 1 in-hospital death (1.4%) and respectively 2 (3%),4 (6%) and 3 (4%) in BMS group. No incidents of stent thrombosis, stroke and emergent CABG occurred during hospitalisation in either group. SES patients showed a lower late lumen loss (0.5+/-0.8 mm vs 1.1+/-1.0 mm; p<0.05) and a lower nine-month angiographic restenosis rate (13.6% vs 24.3%; p=NS). The MACE free survival rate at 2 years was 83% in the SES group vs 55% in the BMS group (p<0.001). SES implantation for unprotected LMCA stenosis in "real world" population appears safe with a low restenosis and MACE rate at follow-up.