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European Heart Journal Advance Access originally published online on March 10, 2009
European Heart Journal 2009 30(10):1171-1179; doi:10.1093/eurheartj/ehp052
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Are drug-eluting stents superior to bare-metal stents in patients with unprotected non-bifurcational left main disease? Insights from a multicentre registry

Corrado Tamburino1,*, Maria Elena Di Salvo1, Davide Capodanno1, Antonio Marzocchi2, Imad Sheiban3, Massimo Margheri4, Aleardo Maresta5, Fabio Barlocco6, Giuseppe Sangiorgi7, Giancarlo Piovaccari8, Antonio Bartorelli9, Carlo Briguori10, Diego Ardissino10, Francesco Di Pede11, Angelo Ramondo12, Luigi Inglese13, Anna Sonia Petronio14, Leonardo Bolognese15, Alberto Benassi16, Cataldo Palmieri17, Aldo Patti18 and Stefano De Servi6

1 Dipartimento di Cardiologia, Ospedale Ferrarotto, Università di Catania, via Citelli 6, 95124 Catania, Italy
2 Istituto di Cardiologia, Policlinico S. Orsola, Università di Bologna, Bologna, Italy
3 Divisione di Cardiologia, Ospedale Universitario Le Molinette, Torino, Italy
4 Dipartimento Cardiovascolare, Ospedale Careggi, Università di Firenze, Firenze, Italy
5 Dipartimento di Cardiologia, Ospedale S. Maria delle Croci, Università di Ravenna, Ravenna, Italy
6 Dipartimento di Malattie Cardiovascolari, Ospedale Civile, Legnano, Italy
7 Centro Emocolumbus, Milano, Italy
8 Dipartimento di Cardiologia, Ospedale degli Infermi, Rimini, Italy
9 Centro Cardiologico Monzino, Milano, Italy
10 Dipartimento di Cardiologia, Clinica Mediterranea, Napoli, Italy
11 Dipartimento di Cardiologia, Ospedale Civile, Mestre, Italy
12 Dipartimento di Scienze Cardiovascolari, Università di Padova, Padova, Italy
13 Cardiovascular Interventional Radiology Department, IRCCS Policlinico S. Donato, S. Donato Milanese, Milan, Italy
14 Dipartimento Cardio-Toracico, Ospedale Cisanello, Pisa, Italy
15 Dipartimento Cardiovascolare Ospedale S. Donato, Arezzo, Italy
16 Dipartimento di Cardiologia, Hesperia Hospital, Modena, Italy
17 Istituto di Fisiologia Clinica, CNR, Massa, Italy
18 Dipartimento Cardiovascolare, Ospedale Cervello, Palermo, Italy

Received 26 August 2008; revised 12 December 2008; accepted 23 January 2009; online publish-ahead-of-print 10 March 2009.

* Corresponding author. Tel: +39 (0) 957436201, Fax: +39 (0) 95362429, Email: tambucor{at}unict.it

Aims: To compare long-term clinical outcome following drug-eluting stents (DES) or bare-metal stents (BMS) implantation on lesions located at the ostium or the shaft of the left main in a large real-world population. The advent of DES decreased the risk of unprotected left main coronary artery (ULMCA) restenosis when compared with BMS, but it is unclear if this advantage continues when non-bifurcational lesions are considered.

Methods and results: The GISE-SICI registry is a retrospective, observational multicentre registry promoted by the Italian Society of Invasive Cardiology in which 19 high-volume participating centres enrolled 1453 consecutive patients who underwent percutaneous coronary intervention on ULMCA between January 2002 and December 2006. From the registry, a total of 479 consecutive patients with ostial and shaft lesions who underwent DES (n = 334) or BMS (n = 145) implantation were analysed with extensive multivariable and propensity score adjustments. At 3-year follow-up, risk-adjusted survival rates were higher in patients treated with DES than in those treated with BMS. The adjusted hazard ratio (HR) for the risk of mortality after DES implantation relative to BMS implantation was 0.37 (95% CI: 0.15–0.96, P = 0.04). The adjusted HR for the risk of cardiac mortality was 0.31 (95% CI: 0.09–1.04, P = 0.06). The adjusted 3-year rates of target lesion revascularization (TLR) were not significantly lower in the DES group than in the BMS group (P = 0.60).

Conclusion: In a large population of patients with lesions located at the ostium or the shaft of the left main in a real-world setting, DES were associated with favourable clinical outcomes when compared with BMS, although there was no evidence of a significant reduction in TLR with DES vs. BMS.

Key Words: Unprotected left main • Drug-eluting stent • Restenosis


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