Key result
DES is linked to ~39% lower 5-year MACE risk vs. BMS in unprotected left main CAD.
Why the study?
It is unclear whether drug-eluting stents have better long-term outcomes than bare-metal stents in patients with left main coronary artery disease in Chinese populations.
Does drug-eluting stent implantation reduce major adverse cardiac events compared to bare-metal stent implantation in patients with unprotected left main coronary artery disease?
Cohort (n=1,136)
Yes
Does drug-eluting stent implantation reduce major adverse cardiac events compared to bare-metal stent implantation in patients with unprotected left main coronary artery disease?
Absolute Event Rate: 19.4% vs 31.8%
p-value: p=0.022
In patients with unprotected left main coronary artery disease, drug-eluting stent implantation is associated with significantly lower 5-year rates of MACE, cardiovascular death, and myocardial infarction compared to bare-metal stents, without an increased risk of stent thrombosis.
May favor DES over BMS for unprotected left main disease; leaves open need for randomized confirmation before practice change.
BACKGROUND: Recent studies reported that percutaneous coronary intervention with stent implantation was safe and feasible for the treatment of left main coronary artery (LMCA) disease in select patients. However, it is unclear whether drug-eluting stents (DESs) have better outcomes in patients with LMCA disease compared with bare-metal stent (BMS) during long-term follow-up in Chinese populations. METHODS: From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups: 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events (MACEs), including cardiovascular (CV) death, myocardial infarction (MI), and target lesion revascularization (TLR) at 5 years postimplantation. RESULTS: Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE (19.4% vs. 31.8%, P = 0.022), CV death (7.0% vs. 14.7%, P = 0.045), and MI (5.4% vs. 12.4%, P = 0.049) than the BMS group. There were no significant differences in the rate of TLR (10.9% vs. 17.8%, P = 0.110) and stent thrombosis (4.7% vs. 3.9%, P = 0.758). The rates of MACE (80.6% vs. 68.2%, P = 0.023), CV death (93.0% vs. 85.3%, P = 0.045), TLR (84.5% vs. 72.1%, P = 0.014), and MI (89.9% vs. 80.6%, P = 0.029) free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and MI were 0.41 (95% confidence interval [CI]: 0.21-0.63, P = 0.029) and 0.29 (95% CI: 0.08-0.92, P = 0.037), respectively. CONCLUSIONS: DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.
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Wang et al. (2015) conducted a cohort in Unprotected left main coronary artery (ULMCA) stenosis (n=1,136). Drug-eluting stent (DES) vs. Bare-metal stent (BMS) was evaluated on Major adverse cardiac events (MACEs) at 5 years (p=0.022). Drug-eluting stent implantation significantly reduced the 5-year rate of major adverse cardiac events to 19.4% compared to 31.8% with bare-metal stents in patients with unprotected left main coronary artery disease.
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