Three-Year Outcomes After Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease Insights From the j-Cypher Registry

Background-Long-term outcomes after stenting of an unprotected left main coronary artery (ULMCA) with drug-eluting stents have not been addressed adequately despite the growing popularity of this procedure. Methods and Results-j-Cypher is a multicenter prospective registry of consecutive patients undergoing sirolimus-eluting stent implantation in Japan. Among 12 824 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 3 years was significantly higher in patients with ULMCA stenting (n = 582) than in patients without ULMCA stenting (n = 12 242; 14.6% versus 9.2%, respectively; P < 0.0001); however, there was no significant difference between the 2 groups in the adjusted risk of death (hazard ratio 1.23, 95% confidence interval 0.95 to 1.60, P = 0.12). Among 476 patients whose ULMCA lesions were treated exclusively with a sirolimus-eluting stent, patients with ostial/shaft lesions (n = 96) compared with those with bifurcation lesions (n = 380) had a significantly lower rate of target-lesion revascularization for the ULMCA lesions (3.6% versus 17.1%, P = 0.005), with similar cardiac death rates at 3 years (9.8% versus 7.6%, P = 0.41). Among patients with bifurcation lesions, patients with stenting of both the main and side branches (n = 119) had significantly higher rates of cardiac death (12.2% versus 5.5%; P = 0.02) and target-lesion revascularization (30.9% versus 11.1%; P < 0.0001) than those with main-branch stenting alone (n = 261). Conclusions-The higher unadjusted mortality rate of patients undergoing ULMCA stenting with a sirolimus-eluting stent did not appear to be related to ULMCA treatment itself but rather to the patients' high-risk profile. Although long-term outcomes in patients with ostial/shaft ULMCA lesions were favorable, outcomes in patients with bifurcation lesions treated with stenting of both the main and side branches appeared unacceptable. (Circulation. 2009;120:1866-1874.)