Long-term clinical outcomes after sirolimus-eluting stent implantation for unprotected left main coronary artery disease
Related Experiment Video
Updated: Apr 24, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Hirooki Higami1, Hiroki Shiomi, Shunichiro Niki
1Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Insights
Sirolimus-eluting stents (SES) show favorable long-term outcomes for unprotected left main coronary artery (LMCA) disease. While overall serious adverse events were low, complex lesions requiring two-stenting increased risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Long-term outcomes of drug-eluting stents (DES) in unprotected left main coronary artery (LMCA) disease are crucial due to late adverse event concerns.
- Previous studies on long-term clinical outcomes (≥5 years) following DES implantation for unprotected LMCA disease are limited.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of sirolimus-eluting stents (SES) in patients with unprotected left main coronary artery (LMCA) disease.
- To assess the incidence of serious cardiovascular events related to the LMCA lesion after SES implantation.
Main Methods:
- A single-center study evaluated 134 consecutive patients who received SES for unprotected LMCA lesions between 2004 and 2009.
- Median follow-up duration was 3.8 years (range: 0.5-7.9 years).
- Primary outcome was serious cardiovascular events potentially related to the LMCA lesion.
Main Results:
- The cumulative 5-year incidence of the primary outcome measure was 4.4%.
- Cumulative 5-year incidences: all-cause death 26.5%, cardiac death 8.1%, target vessel myocardial infarction 0%, definite stent thrombosis 0%, and target-lesion revascularization 12.9%.
- Patients with two-stenting had a significantly higher incidence of the primary outcome (14.0%) compared to one-stenting (2.2%). All serious adverse events occurred in patients with true bifurcation lesions, with 5 receiving two-stenting.
Conclusions:
- SES implantation for unprotected LMCA lesions demonstrates favorable long-term outcomes with an acceptably low rate of serious adverse events.
- Complex LMCA lesions requiring a two-stenting strategy may be associated with an increased risk of serious adverse events.
Abstract:
Previous studies reporting long-term (≥5 year) clinical outcome in patients with unprotected left main coronary artery (LMCA) disease undergoing drug-eluting stent (DES) implantation are currently limited, although late adverse events beyond 1 year are one of the major concerns of DES. We evaluated long-term clinical outcomes in 134 consecutive patients who underwent sirolimus-eluting stents (SES) for unprotected LMCA lesion in a single center from 2004 to 2009. The median follow-up duration was 3.8 (range: 0.5-7.9) years. Eight patients suffered from serious cardiovascular events potentially related to LMCA lesion (primary outcome measure) (sudden cardiac death: N = 5, emergent coronary revascularization for the LMCA lesion: N = 2, and acute congestive heart failure related to LMCA lesion: N = 1) with the cumulative 5-year incidence of only 4.4 %. The cumulative 5-year incidence of all-cause death, cardiac death, target vessel myocardial infarction, definite stent thrombosis, and target-lesion revascularization was 26.5, 8.1, 0, 0, and 12.9 %, respectively. In a subgroup analysis, the cumulative incidence of the primary outcome measure was significantly higher in patients with 2-stenting (N = 27) than in patients with 1-stenting (N = 107) (14.0 and 2.2 %, P < 0.001). All 8 patients with serious adverse events had a true bifurcation lesion and 5 patients received 2-stenting for the LMCA lesion. SES implantation in patients with unprotected LMCA lesion was associated with a favorable long-term outcome with acceptably low rate of serious adverse event potentially related to LMCA lesion. However, complex LMCA lesions necessitating 2-stenting strategy might be associated with higher risk for serious adverse events.
