Key result
Current generation drug-eluting stents significantly reduced the rate of overall target lesion revascularization compared to early generation stents (adjusted HR 0.62; 95% CI 0.40-0.96; p=0.032).
Why the study?
Little data were available comparing clinical outcomes between early generation drug eluting stents and current generation drug eluting stents for PCI using a double stent strategy in unprotected distal left main disease.
Does current generation drug eluting stent reduce target lesion failure compared to early generation drug eluting stent in patients with unprotected distal left main disease treated with double stent strategy?
Observational (n=452)
Yes
Does current generation drug eluting stent reduce target lesion failure compared to early generation drug eluting stent in patients with unprotected distal left main disease treated with double stent strategy?
Hazard Ratio: 0.62 (95% CI 0.4–0.96)
p-value: p=0.032
Current generation drug eluting stents significantly improve clinical outcomes in patients with unprotected distal left main disease treated with a double stent strategy, primarily by reducing target lesion revascularization for the ostium of the LCX.
May favor current-generation DES to lower TLR in left main double-stent PCI; leaves open randomized confirmation.
BACKGROUND: There are only little data available on the comparison of clinical outcomes between a early generation drug eluting stent (eDES) and a current generation drug eluting stent (cDES) for percutaneous coronary intervention (PCI) with double stent strategy (DSS) for unprotected distal left main disease (ULMD). METHODS: Between April 2005 and December 2015, we recruited 452 consecutive ULMD patients treated with DSS (eDES, 236 patients; cDES, 216 patients). In this study, eDES included Cipher, Taxus, and Endeavor and cDES included Ultimaster, Resolute family, Xience family, Promus family, Synergy, and Nobori. The primary endpoint was target lesion failure (TLF) defined as a composite of cardiac death, target lesion revascularization (TLR) and myocardial infarction (MI) during the median follow-up period of 1,809(IQR: 1,190-2,510) days. RESULTS: In entire population, the rate of overall TLR was significantly lower in cDES group than that in eDES group (adjusted HR 0.62, 95% CI 0.40-0.96, p = .032). The rate of TLR for the ostium of LCX was significantly lower in cDES group than that in eDES group (adjusted HR 0.63, 95% CI 0.39-0.99, p = .047). Cardiac mortality, the rate of TLR for LM-LAD, MI and definite/probable ST did not significantly differ between both groups. The results were preserved in the propensity adjusted population. CONCLUSIONS: cDES significantly improved the clinical outcomes in population treated with DSS mainly driven by the reduction of TLR for the ostium of LCX.
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Watanabe et al. (2020) conducted an observational in Unprotected distal left main disease (ULMD) (n=452). Current generation drug eluting stent (cDES) vs. Early generation drug eluting stent (eDES) was evaluated on Target lesion failure (TLF) defined as a composite of cardiac death, target lesion revascularization (TLR) and myocardial infarction (MI) (adjusted HR 0.62, 95% CI 0.40-0.96, p=0.032). Current generation drug-eluting stents significantly reduced the rate of overall target lesion revascularization compared to early generation stents (adjusted HR 0.62; 95% CI 0.40-0.96; p=0.032).
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