Two-year (mid-term) results for unprotected left main coronary artery percutaneous interventions with drug-eluting...

Bypass surgery remains the revascularization strategy of choice for left main trunk coronary artery disease in an unselected group of patients. Drug eluting stents have been proposed as a viable alternative to bypass surgery for left main trunk lesions but their intermediate and long term outcomes are still under scrutiny.

A series of 50 patients with significant unprotected left main trunk stenosis (>50%) underwent revascularization with drug eluting stents (sirolimus and paclitaxel stents) and were enrolled in a registry. Follow up angiography was clinically driven. Recurrent chest pain and ischemia on myocardial perfusion imaging were clinical parameters that mandated repeat angiography. Prespecified primary endpoints of this registry were defined as major adverse cardiac event at 2 year follow up.

No differences in outcomes were noted with either type of drug eluting stent used in this study (Sirolimus versus Paclitaxel). The low major adverse cardiac event rate of 14% at 2 years warrants a randomized control trial in a low surgical risk group of patients comparing bypass grafting with left main trunk percutaneous intervention.

This registry confirms findings by other investigators about the safety of unprotected LMT stenting in an unselected group of patients. The acceptable MACE rate at 2 years from registries such as this suggests the need for a randomized control trial comparing the two strategies.