文摘
The use of paclitaxel-eluting stents (PES) for the treatment of unprotected left main coronary artery (LMCA) disease is controversial. Between January 2003 and December 2006, a total of 287 patients undergoing percutaneous coronary intervention for LMCA lesions were consecutively registered. Of those patients, 178 received PES and 109 received bare-metal stents (BMS). Estimated perioperative mortality rates were 7.3 % and 6.8 % for the BMS and PES groups, respectively (p = 0.51). PES recipients had distal left main bifurcation lesions more frequently compared with BMS recipients (72 vs 42 % , p <0.01). At an average follow-up of 35 months, the rates of major adverse cardiac events (4.5 vs 23.9 % , adjusted odds ratio [OR] 0.23, 95 % confidence interval [CI] 0.09 to 0.58, p <0.001) and target-lesion revascularization (2.2 vs 13.8 % , adjusted OR 0.26, 95 % CI 0.08 to 0.83, p <0.001) were significantly lower in the PES group than in the BMS group. Overall thrombotic event rates were 1.1 % and 4.6 % in the PES and BMS groups, respectively (p = 0.08). Angiographic follow-up was performed in 61 % and 59 % of PES and BMS recipients, respectively. The angiographic restenosis rate was significantly lower in the PES group as compared with the BMS group (3.7 vs 23.4 % , p <0.001). In conclusion, PES implantation provides a safe, effective therapy for unprotected LMCA disease and decreases the risk of major adverse cardiac events compared with BMS at a mean follow-up of 35 months.
