- 作者：Mamoru Toyofuku ; Takeshi Kimura ; Takeshi Morimoto ; Yasuhiko Hayashi ; Nobuo Shiode ; Hideo Nishikawa ; Koichi Nakao ; Kinya Shirota ; Kazuya Kawai ; Yoshikazu Hiasa ; Kazushige Kadota ; Yoichi Nozaki ; Takaaki Isshiki ; Takahito Sone ; Kazuaki Mitsudo ; j-Cypher Registry Investigators
- 关键词：bifurcation ; left main disease ; sirolimus-eluting stent
- 刊名：JACC: Cardiovascular Interventions
- 出版年：2013
- 出版时间：July, 2013
- 年：2013
- 卷：6
- 期：7
- 页码：654-663
- 全文大小：1167 K
Objectives
This study assessed 5-year outcomes after implantation of sirolimus-eluting stents (SES) for unprotected left main coronary artery (ULMCA) disease in comparison with that for non-left main disease.Background
More information on long-term outcomes after ULMCA stenting is needed.
Methods
The j-Cypher is a multicenter prospective registry of consecutive patients undergoing SES implantation in Japan.
Results
Among 12,812 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 5?years was significantly higher in patients with ULMCA stenting than in patients without ULMCA stenting (22.8 % vs. 14.1 % ; p < 0.0001); however, the risk for death with ULMCA stenting was no longer significant after adjusting for confounders (hazard ratio: 1.18, 95 % confidence interval: 0.95 to 1.46; p?=?0.14). In the lesion-level comparison, the nonbifurcation ULMCA lesions treated exclusively with SES had a significantly lower rate of target lesion revascularization (TLR) than those in non-ULMCA nonbifurcation lesions (2.4 % vs. 12.7 % ; p?= 0.04). Among bifurcation lesions, those treated with a provisional 2-stent approach had similar rates of TLR (12.1 % vs. 11.4 % ; p?= 0.79) between the ULMCA and non-ULMCA groups. Lesions treated with an elective 2-stent approach had higher TLR rates in the ULMCA group as compared with the non-ULMCA group (33.5 % vs. 19.7 % ; p?= 0.002).
Conclusions
The safety of ULMCA stenting relative to non-LMCA stenting was maintained through 5?years follow-up. In terms of efficacy, SES implantation in nonbifurcation ULMCA lesions was associated with an extremely low cumulative incidence of TLR, whereas the elective 2-stent approach for ULMCA bifurcation lesions was associated with a markedly higher cumulative incidence of TLR as compared with that for non-ULMCA bifurcation lesions.