Long-term outcomes following drug-eluting stent implantation in unprotected left main bifurcation lesions

Background The safety and efficacy of drug-eluting stents(DES)implantation in unprotected left main(LM)bifurcation lesions has yet to be determined.The aim of the present report was to evaluate the long-term outcomefollowing implantation of DES in unprotected LM bifurcation lesions.Methods We identified 70 consecutive patients treated with DES in unprotected LM bifurcation lesions from April 2003to January 2005.Of them,42 patients were treated with sirolimus-eluting stent(SES)and 28 patients were treated withpaclitaxel-eluting stent(PES).Results Stents to the left anterior descending and to the circumflex were implanted in 62 patients.During 1-yearfollow-up,3(4.3%)patients died of cardiac causes.One of them had myocardial infarction and adjudicated as possiblydue to stent thrombosis.Angiographic follow-up was available in 80% of patients.The per lesion restenosis rate was13.4% in the entire cohort,of which 10.7% occurred in lesions treated with SES and 16.1% in those treated with PES(P=0.58).All restenosis was focal and occurred in the lesions treated with a stent with stent size to post-proceduralreference vessel diameter ratio <1.0(17.6% vs 0,P=0.04).The per patient target lesion revascularization rate at 1 yearwas 17.1%.One year survival free from major adverse cardiac events was 77.1%.Conclusions Treatment of LM bifurcation lesions using DES is a safe and feasible way with a low one-year mortality.The need for revascularization in 17% of patients demands for improvement.