Comparison of 5-Year Outcomes in Patients With and Without Unprotected Left Main Coronary Artery Disease After Treatment With Sirolimus-Eluting Stents Insights From the j-Cypher Registry

被引：15

作者：

Toyofuku, Mamoru ^{[1
]}

Kimura, Takeshi ^{[2
]}

Morimoto, Takeshi ^{[3
]}

Hayashi, Yasuhiko ^{[4
]}

Shiode, Nobuo ^{[4
]}

Nishikawa, Hideo ^{[5
]}

Nakao, Koichi ^{[6
]}

Shirota, Kinya ^{[7
]}

Kawai, Kazuya ^{[8
]}

Hiasa, Yoshikazu ^{[9
]}

Kadota, Kazushige ^{[10
]}

Nozaki, Yoichi ^{[11
]}

Isshiki, Takaaki ^{[12
]}

Sone, Takahito ^{[13
]}

Mitsudo, Kazuaki ^{[10
]}

机构：

[1] Wakayama Med Ctr, Wakayama, Japan

[2] Kyoto Univ, Kyoto 6068507, Japan

[3] Kinki Univ, Sch Med, Ctr Gen Internal Med & Emergency Care, Osaka 589, Japan

[4] Tsuchiya Gen Hosp, Hiroshima, Japan

[5] Mie Heart Ctr, Tsu, Mie, Japan

[6] Saiseikai Kumamoto Hosp, Kumamoto, Japan

[7] Matsue Red Cross Hosp, Matsue, Shimane, Japan

[8] Chikamori Hosp, Kochi, Japan

[9] Tokushima Red Cross Hosp, Komatsushima, Japan

[10] Kurashiki Cent Hosp, Kurashiki, Okayama, Japan

[11] Hokko Mem Hosp, Sapporo, Hokkaido, Japan

[12] Teikyo Univ Hosp, Tokyo, Japan

[13] Ogaki Municipal Hosp, Ogaki, Japan

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2013年 / 6卷 / 07期

关键词：

bifurcation; left main disease; sirolimus-eluting stent; TASK-FORCE; INTERVENTION; REVASCULARIZATION; SURGERY; ANGIOPLASTY; ASSOCIATION; GUIDELINES; THROMBOSIS; SOCIETY; LESIONS;

D O I：

10.1016/j.jcin.2013.03.015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (c) 2013 by the American College of Cardiology Foundation

引用

页码：654 / 663

页数：10

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