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Comparison of 5-year outcomes in patients with and without unprotected left main coronary artery disease after treatment with sirolimus-eluting stents: insights from the j-Cypher registry.
JACC Cardiovasc Interv. 2013 Jul; 6(7):654-63.JC

Abstract

OBJECTIVES

This study assessed 5-year outcomes after implantation of sirolimus-eluting stents (SES) for unprotected left main coronary artery (ULMCA) disease in comparison with that for non-left main disease.

BACKGROUND

More information on long-term outcomes after ULMCA stenting is needed.

METHODS

The j-Cypher is a multicenter prospective registry of consecutive patients undergoing SES implantation in Japan.

RESULTS

Among 12,812 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 5 years was significantly higher in patients with ULMCA stenting than in patients without ULMCA stenting (22.8% vs. 14.1%; p < 0.0001); however, the risk for death with ULMCA stenting was no longer significant after adjusting for confounders (hazard ratio: 1.18, 95% confidence interval: 0.95 to 1.46; p = 0.14). In the lesion-level comparison, the nonbifurcation ULMCA lesions treated exclusively with SES had a significantly lower rate of target lesion revascularization (TLR) than those in non-ULMCA nonbifurcation lesions (2.4% vs. 12.7%; p = 0.04). Among bifurcation lesions, those treated with a provisional 2-stent approach had similar rates of TLR (12.1% vs. 11.4%; p = 0.79) between the ULMCA and non-ULMCA groups. Lesions treated with an elective 2-stent approach had higher TLR rates in the ULMCA group as compared with the non-ULMCA group (33.5% vs. 19.7%; p = 0.002).

CONCLUSIONS

The safety of ULMCA stenting relative to non-LMCA stenting was maintained through 5 years follow-up. In terms of efficacy, SES implantation in nonbifurcation ULMCA lesions was associated with an extremely low cumulative incidence of TLR, whereas the elective 2-stent approach for ULMCA bifurcation lesions was associated with a markedly higher cumulative incidence of TLR as compared with that for non-ULMCA bifurcation lesions.

Authors+Show Affiliations

Wakayama Medical Center, Wakayama, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23866178

Citation

Toyofuku, Mamoru, et al. "Comparison of 5-year Outcomes in Patients With and Without Unprotected Left Main Coronary Artery Disease After Treatment With Sirolimus-eluting Stents: Insights From the j-Cypher Registry." JACC. Cardiovascular Interventions, vol. 6, no. 7, 2013, pp. 654-63.
Toyofuku M, Kimura T, Morimoto T, et al. Comparison of 5-year outcomes in patients with and without unprotected left main coronary artery disease after treatment with sirolimus-eluting stents: insights from the j-Cypher registry. JACC Cardiovasc Interv. 2013;6(7):654-63.
Toyofuku, M., Kimura, T., Morimoto, T., Hayashi, Y., Shiode, N., Nishikawa, H., Nakao, K., Shirota, K., Kawai, K., Hiasa, Y., Kadota, K., Nozaki, Y., Isshiki, T., Sone, T., & Mitsudo, K. (2013). Comparison of 5-year outcomes in patients with and without unprotected left main coronary artery disease after treatment with sirolimus-eluting stents: insights from the j-Cypher registry. JACC. Cardiovascular Interventions, 6(7), 654-63. https://doi.org/10.1016/j.jcin.2013.03.015
Toyofuku M, et al. Comparison of 5-year Outcomes in Patients With and Without Unprotected Left Main Coronary Artery Disease After Treatment With Sirolimus-eluting Stents: Insights From the j-Cypher Registry. JACC Cardiovasc Interv. 2013;6(7):654-63. PubMed PMID: 23866178.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of 5-year outcomes in patients with and without unprotected left main coronary artery disease after treatment with sirolimus-eluting stents: insights from the j-Cypher registry. AU - Toyofuku,Mamoru, AU - Kimura,Takeshi, AU - Morimoto,Takeshi, AU - Hayashi,Yasuhiko, AU - Shiode,Nobuo, AU - Nishikawa,Hideo, AU - Nakao,Koichi, AU - Shirota,Kinya, AU - Kawai,Kazuya, AU - Hiasa,Yoshikazu, AU - Kadota,Kazushige, AU - Nozaki,Yoichi, AU - Isshiki,Takaaki, AU - Sone,Takahito, AU - Mitsudo,Kazuaki, AU - ,, PY - 2013/01/18/received PY - 2013/03/22/revised PY - 2013/03/28/accepted PY - 2013/7/20/entrez PY - 2013/7/20/pubmed PY - 2014/2/15/medline KW - CABG KW - CI KW - HR KW - LCX KW - MI KW - PCI KW - SES KW - ST KW - TLR KW - ULMCA KW - bifurcation KW - confidence interval KW - coronary artery bypass grafting KW - hazard ratio KW - left circumflex coronary artery KW - left main disease KW - myocardial infarction KW - percutaneous coronary intervention KW - sirolimus-eluting stent KW - sirolimus-eluting stent(s) KW - stent thrombosis KW - target-lesion revascularization KW - unprotected left main coronary artery SP - 654 EP - 63 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 6 IS - 7 N2 - OBJECTIVES: This study assessed 5-year outcomes after implantation of sirolimus-eluting stents (SES) for unprotected left main coronary artery (ULMCA) disease in comparison with that for non-left main disease. BACKGROUND: More information on long-term outcomes after ULMCA stenting is needed. METHODS: The j-Cypher is a multicenter prospective registry of consecutive patients undergoing SES implantation in Japan. RESULTS: Among 12,812 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 5 years was significantly higher in patients with ULMCA stenting than in patients without ULMCA stenting (22.8% vs. 14.1%; p < 0.0001); however, the risk for death with ULMCA stenting was no longer significant after adjusting for confounders (hazard ratio: 1.18, 95% confidence interval: 0.95 to 1.46; p = 0.14). In the lesion-level comparison, the nonbifurcation ULMCA lesions treated exclusively with SES had a significantly lower rate of target lesion revascularization (TLR) than those in non-ULMCA nonbifurcation lesions (2.4% vs. 12.7%; p = 0.04). Among bifurcation lesions, those treated with a provisional 2-stent approach had similar rates of TLR (12.1% vs. 11.4%; p = 0.79) between the ULMCA and non-ULMCA groups. Lesions treated with an elective 2-stent approach had higher TLR rates in the ULMCA group as compared with the non-ULMCA group (33.5% vs. 19.7%; p = 0.002). CONCLUSIONS: The safety of ULMCA stenting relative to non-LMCA stenting was maintained through 5 years follow-up. In terms of efficacy, SES implantation in nonbifurcation ULMCA lesions was associated with an extremely low cumulative incidence of TLR, whereas the elective 2-stent approach for ULMCA bifurcation lesions was associated with a markedly higher cumulative incidence of TLR as compared with that for non-ULMCA bifurcation lesions. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/23866178/Comparison_of_5_year_outcomes_in_patients_with_and_without_unprotected_left_main_coronary_artery_disease_after_treatment_with_sirolimus_eluting_stents:_insights_from_the_j_Cypher_registry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(13)00813-3 DB - PRIME DP - Unbound Medicine ER -