Early and long-term results of unprotected left main coronary artery stenting: the LE MANS (Left Main Coronary Artery Stenting) registry.

Pawel E. Buszman, Piotr P. Buszman, R. Stefan Kiesz, Andrzej Bochenek, Blazej Trela, Magda Konkolewska, David Wallace-Bradley, Mirosław Wilczyński, Iwona Banasiewicz-Szkróbka, Ewa Peszek-Przybyla, Marek Krol, Marek Kondys, Krzysztof Milewski, Szymon Wiernek, Marcin Debiński, Aleksander Zurakowski, Jack L. Martin, Michał Tendera

Research output: Contribution to journalArticle

95 Scopus citations

Abstract

OBJECTIVES: The aim of the study was to evaluate early and late outcomes after percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCA) and to compare bare-metal stent (BMS) and drug-eluting stent (DES) subgroups. BACKGROUND: PCI is an increasingly utilized method of revascularization in patients with ULMCA. METHODS: This multicenter prospective registry included 252 patients after ULMCA stenting enrolled between March 1997 and February 2008. Non-ST-segment elevation acute coronary syndrome was diagnosed in 58% of patients; ST-segment elevation myocardial infarction cases were excluded. Drug-eluting stents were implanted in 36.2% of patients. RESULTS: Major adverse cardiovascular and cerebral events (MACCE) occurred in 12 (4.8%) patients during the 30-day period, which included 4 (1.5%) deaths. After 12 months there were 17 (12.1%) angiographically confirmed cases of restenosis. During long-term follow-up (1 to 11 years, mean 3.8 years) there were 64 (25.4%) MACCE and 35 (13.9%) deaths. The 5- and 10-year survival rates were 78.1% and 68.9%, respectively. Despite differences in demographical and clinical data in favor of BMS patients, unmatched analysis showed a significantly lower MACCE rate in DES patients (25.9% vs. 14.9%, p = 0.039). This difference was strengthened after propensity score matching. The DES lowered both mortality and MACCE for distal ULMCA lesions when compared with BMS. Ejection fraction <50% was the only independent risk factor influencing long-term survival. CONCLUSIONS: Stenting of ULMCA is feasible and offers good long-term outcome. Implantation of DES for ULMCA decreased the risk of long-term MACCE, and particularly improved survival in patients with distal ULMCA disease.

Original languageEnglish (US)
Pages (from-to)1500-1511
Number of pages12
JournalJournal of the American College of Cardiology
Volume54
Issue number16
StatePublished - Oct 13 2009
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Buszman, P. E., Buszman, P. P., Kiesz, R. S., Bochenek, A., Trela, B., Konkolewska, M., Wallace-Bradley, D., Wilczyński, M., Banasiewicz-Szkróbka, I., Peszek-Przybyla, E., Krol, M., Kondys, M., Milewski, K., Wiernek, S., Debiński, M., Zurakowski, A., Martin, J. L., & Tendera, M. (2009). Early and long-term results of unprotected left main coronary artery stenting: the LE MANS (Left Main Coronary Artery Stenting) registry. Journal of the American College of Cardiology, 54(16), 1500-1511.