Interventional Cardiology
Long-Term Clinical Outcomes of Sirolimus- Versus Paclitaxel-Eluting Stents for Patients With Unprotected Left Main Coronary Artery Disease: Analysis of the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) Registry

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Objectives

The aim of this study was to evaluate long-term clinical outcomes after implantation of sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES) among patients with unprotected left main coronary artery (LMCA) disease.

Background

There have been few comparisons of long-term outcomes among currently available drug-eluting stents (DES) for the treatment of LMCA disease.

Methods

A total of 858 consecutive patients with unprotected LMCA stenosis were treated with SES (n = 669) or PES (n = 189) between May 2003 and June 2006. Primary outcome was the composite of death, myocardial infarction (MI), or target vessel revascularization (TVR).

Results

Baseline clinical and angiographic characteristics were similar in the 2 groups. During 3 years of follow-up, the adjusted risk of primary composite outcome was similar among the groups (SES vs. PES: 25.8% vs. 25.7%, hazard ratio [HR]: 0.95, 95% confidence interval [CI]: 0.64 to 1.41, p = 0.79). The 2 groups also showed a comparable adjusted rate of each component of outcome: death (9.1% vs. 11.0%, HR: 0.92, 95% CI: 0.47 to 1.80, p = 0.82), MI (8.1% vs. 8.0%, HR: 0.80, 95% CI: 0.43 to 1.48, p = 0.47), and TVR (12.1% vs. 10.6%, HR: 1.10, 95% CI: 0.53 to 2.29, p = 0.81). The 3-year rates of definite or probable stent thrombosis were 0.6% in the SES group and 1.6% in the PES group (adjusted p = 0.18).

Conclusions

In consecutive patients with unprotected LMCA disease undergoing DES implantation, SES and PES showed similar long-term clinical outcomes in terms of death, MI, repeat revascularization, and stent thrombosis.

Key Words

drug-eluting stent
left main coronary artery disease
PCI

Abbreviations and Acronyms

CABG
coronary artery bypass grafting
DES
drug-eluting stent(s)
LMCA
left main coronary artery
MI
myocardial infarction
PCI
percutaneous coronary intervention
PES
paclitaxel-eluting stent(s)
SES
sirolimus-eluting stent(s)
TVR
target vessel revascularization

Cited by (0)

This study was partly supported by the Cardiovascular Research Foundation, Seoul, Korea, and a Grant of the Korea Health 21 R&D Project, Ministry of Health & Welfare, Korea (0412-CR02-0704-0001). Drs. Jong-Young Lee and Duk-Woo Park contributed equally to this work.