Everolimus-eluting stent implantation for unprotected left main coronary artery stenosis

The PRECOMBAT-2 (premier of randomized comparison of bypass surgery versus angioplasty using sirolimus-eluting stent in patients with left main coronary artery disease) study

Young Hak Kim, Duk Woo Park, Jung Min Ahn, Sung Cheol Yun, Hae Geun Song, Jong Young Lee, Won Jang Kim, Soo Jin Kang, Seung Whan Lee, Cheol Whan Lee, Seong Wook Park, Yangsoo Jang, Myung Ho Jeong, Hyo Soo Kim, Seung Ho Hur, Seung Woon Rha, Do Sun Lim, Sung Ho Her, Ki Bae Seung, In Whan Seong & 1 others Seung Jung Park

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Objectives: This study sought to evaluate the safety and efficacy of second-generation drug-eluting stents (DES) for patients with unprotected left main coronary artery (ULMCA) stenosis. Background: The clinical benefit of second-generation DES for ULMCA stenosis has not been determined. Methods: The authors assessed 334 consecutive patients who received everolimus-eluting stents (EES) for ULMCA stenosis between 2009 and 2010. The 18-month incidence rates of major adverse cardiac or cerebrovascular events (MACCE), including death, myocardial infarction (MI), stroke, or ischemia-driven target vessel revascularization (TVR), were compared with those of a randomized study comparing patients who received sirolimus-eluting stents (SES) (n = 327) or coronary artery bypass grafts (CABG) (n = 272). Results: EES (8.9%) showed a comparable incidence of MACCE as SES (10.8%; adjusted hazard ratio [aHR] of EES: 0.84; 95% confidence interval [CI]: 0.51 to 1.40; p = 0.51) and CABG (6.7%, aHR of EES: 1.40; 95% CI: 0.78 to 2.54; p = 0.26). The composite incidence of death, MI, or stroke also did not differ among patients receiving EES (3.3%), SES (3.7%; aHR of EES: 0.63; 95% CI: 0.27 to 1.47; p = 0.29), and CABG (4.8%; aHR of EES: 0.67; 95% CI: 0.29 to 1.54; p = 0.34). However, the incidence of ischemia-driven TVR in the EES group (6.5%) was higher than in the CABG group (2.6%, aHR of EES: 2.77; 95% CI: 1.17 to 6.58; p = 0.02), but comparable to SES (8.2%, aHR of EES: 1.14; 95% CI: 0.64 to 2.06; p = 0.65). Angiographic restenosis rates were similar in the SES and EES groups (13.8% vs. 9.2%, p = 0.16). Conclusions: Second-generation EES had a similar 18-month risk of MACCE for ULMCA stenosis as first-generation SES or CABG. (Evaluation of Outcomes of EES Implantation for Unprotected Left Main Coronary Artery Stenosis [PRECOMBAT-2]; NCT01348022)

Original languageEnglish
Pages (from-to)708-717
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume5
Issue number7
DOIs
Publication statusPublished - 2012 Jul 1

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Coronary Stenosis
Sirolimus
Angioplasty
Stents
Coronary Artery Disease
Coronary Artery Bypass
Confidence Intervals
Transplants
Everolimus
Drug-Eluting Stents
Incidence
Stroke
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kim, Young Hak ; Park, Duk Woo ; Ahn, Jung Min ; Yun, Sung Cheol ; Song, Hae Geun ; Lee, Jong Young ; Kim, Won Jang ; Kang, Soo Jin ; Lee, Seung Whan ; Lee, Cheol Whan ; Park, Seong Wook ; Jang, Yangsoo ; Jeong, Myung Ho ; Kim, Hyo Soo ; Hur, Seung Ho ; Rha, Seung Woon ; Lim, Do Sun ; Her, Sung Ho ; Seung, Ki Bae ; Seong, In Whan ; Park, Seung Jung. / Everolimus-eluting stent implantation for unprotected left main coronary artery stenosis : The PRECOMBAT-2 (premier of randomized comparison of bypass surgery versus angioplasty using sirolimus-eluting stent in patients with left main coronary artery disease) study. In: JACC: Cardiovascular Interventions. 2012 ; Vol. 5, No. 7. pp. 708-717.
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title = "Everolimus-eluting stent implantation for unprotected left main coronary artery stenosis: The PRECOMBAT-2 (premier of randomized comparison of bypass surgery versus angioplasty using sirolimus-eluting stent in patients with left main coronary artery disease) study",
abstract = "Objectives: This study sought to evaluate the safety and efficacy of second-generation drug-eluting stents (DES) for patients with unprotected left main coronary artery (ULMCA) stenosis. Background: The clinical benefit of second-generation DES for ULMCA stenosis has not been determined. Methods: The authors assessed 334 consecutive patients who received everolimus-eluting stents (EES) for ULMCA stenosis between 2009 and 2010. The 18-month incidence rates of major adverse cardiac or cerebrovascular events (MACCE), including death, myocardial infarction (MI), stroke, or ischemia-driven target vessel revascularization (TVR), were compared with those of a randomized study comparing patients who received sirolimus-eluting stents (SES) (n = 327) or coronary artery bypass grafts (CABG) (n = 272). Results: EES (8.9{\%}) showed a comparable incidence of MACCE as SES (10.8{\%}; adjusted hazard ratio [aHR] of EES: 0.84; 95{\%} confidence interval [CI]: 0.51 to 1.40; p = 0.51) and CABG (6.7{\%}, aHR of EES: 1.40; 95{\%} CI: 0.78 to 2.54; p = 0.26). The composite incidence of death, MI, or stroke also did not differ among patients receiving EES (3.3{\%}), SES (3.7{\%}; aHR of EES: 0.63; 95{\%} CI: 0.27 to 1.47; p = 0.29), and CABG (4.8{\%}; aHR of EES: 0.67; 95{\%} CI: 0.29 to 1.54; p = 0.34). However, the incidence of ischemia-driven TVR in the EES group (6.5{\%}) was higher than in the CABG group (2.6{\%}, aHR of EES: 2.77; 95{\%} CI: 1.17 to 6.58; p = 0.02), but comparable to SES (8.2{\%}, aHR of EES: 1.14; 95{\%} CI: 0.64 to 2.06; p = 0.65). Angiographic restenosis rates were similar in the SES and EES groups (13.8{\%} vs. 9.2{\%}, p = 0.16). Conclusions: Second-generation EES had a similar 18-month risk of MACCE for ULMCA stenosis as first-generation SES or CABG. (Evaluation of Outcomes of EES Implantation for Unprotected Left Main Coronary Artery Stenosis [PRECOMBAT-2]; NCT01348022)",
author = "Kim, {Young Hak} and Park, {Duk Woo} and Ahn, {Jung Min} and Yun, {Sung Cheol} and Song, {Hae Geun} and Lee, {Jong Young} and Kim, {Won Jang} and Kang, {Soo Jin} and Lee, {Seung Whan} and Lee, {Cheol Whan} and Park, {Seong Wook} and Yangsoo Jang and Jeong, {Myung Ho} and Kim, {Hyo Soo} and Hur, {Seung Ho} and Rha, {Seung Woon} and Lim, {Do Sun} and Her, {Sung Ho} and Seung, {Ki Bae} and Seong, {In Whan} and Park, {Seung Jung}",
year = "2012",
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Everolimus-eluting stent implantation for unprotected left main coronary artery stenosis : The PRECOMBAT-2 (premier of randomized comparison of bypass surgery versus angioplasty using sirolimus-eluting stent in patients with left main coronary artery disease) study. / Kim, Young Hak; Park, Duk Woo; Ahn, Jung Min; Yun, Sung Cheol; Song, Hae Geun; Lee, Jong Young; Kim, Won Jang; Kang, Soo Jin; Lee, Seung Whan; Lee, Cheol Whan; Park, Seong Wook; Jang, Yangsoo; Jeong, Myung Ho; Kim, Hyo Soo; Hur, Seung Ho; Rha, Seung Woon; Lim, Do Sun; Her, Sung Ho; Seung, Ki Bae; Seong, In Whan; Park, Seung Jung.

In: JACC: Cardiovascular Interventions, Vol. 5, No. 7, 01.07.2012, p. 708-717.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Everolimus-eluting stent implantation for unprotected left main coronary artery stenosis

T2 - The PRECOMBAT-2 (premier of randomized comparison of bypass surgery versus angioplasty using sirolimus-eluting stent in patients with left main coronary artery disease) study

AU - Kim, Young Hak

AU - Park, Duk Woo

AU - Ahn, Jung Min

AU - Yun, Sung Cheol

AU - Song, Hae Geun

AU - Lee, Jong Young

AU - Kim, Won Jang

AU - Kang, Soo Jin

AU - Lee, Seung Whan

AU - Lee, Cheol Whan

AU - Park, Seong Wook

AU - Jang, Yangsoo

AU - Jeong, Myung Ho

AU - Kim, Hyo Soo

AU - Hur, Seung Ho

AU - Rha, Seung Woon

AU - Lim, Do Sun

AU - Her, Sung Ho

AU - Seung, Ki Bae

AU - Seong, In Whan

AU - Park, Seung Jung

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Objectives: This study sought to evaluate the safety and efficacy of second-generation drug-eluting stents (DES) for patients with unprotected left main coronary artery (ULMCA) stenosis. Background: The clinical benefit of second-generation DES for ULMCA stenosis has not been determined. Methods: The authors assessed 334 consecutive patients who received everolimus-eluting stents (EES) for ULMCA stenosis between 2009 and 2010. The 18-month incidence rates of major adverse cardiac or cerebrovascular events (MACCE), including death, myocardial infarction (MI), stroke, or ischemia-driven target vessel revascularization (TVR), were compared with those of a randomized study comparing patients who received sirolimus-eluting stents (SES) (n = 327) or coronary artery bypass grafts (CABG) (n = 272). Results: EES (8.9%) showed a comparable incidence of MACCE as SES (10.8%; adjusted hazard ratio [aHR] of EES: 0.84; 95% confidence interval [CI]: 0.51 to 1.40; p = 0.51) and CABG (6.7%, aHR of EES: 1.40; 95% CI: 0.78 to 2.54; p = 0.26). The composite incidence of death, MI, or stroke also did not differ among patients receiving EES (3.3%), SES (3.7%; aHR of EES: 0.63; 95% CI: 0.27 to 1.47; p = 0.29), and CABG (4.8%; aHR of EES: 0.67; 95% CI: 0.29 to 1.54; p = 0.34). However, the incidence of ischemia-driven TVR in the EES group (6.5%) was higher than in the CABG group (2.6%, aHR of EES: 2.77; 95% CI: 1.17 to 6.58; p = 0.02), but comparable to SES (8.2%, aHR of EES: 1.14; 95% CI: 0.64 to 2.06; p = 0.65). Angiographic restenosis rates were similar in the SES and EES groups (13.8% vs. 9.2%, p = 0.16). Conclusions: Second-generation EES had a similar 18-month risk of MACCE for ULMCA stenosis as first-generation SES or CABG. (Evaluation of Outcomes of EES Implantation for Unprotected Left Main Coronary Artery Stenosis [PRECOMBAT-2]; NCT01348022)

AB - Objectives: This study sought to evaluate the safety and efficacy of second-generation drug-eluting stents (DES) for patients with unprotected left main coronary artery (ULMCA) stenosis. Background: The clinical benefit of second-generation DES for ULMCA stenosis has not been determined. Methods: The authors assessed 334 consecutive patients who received everolimus-eluting stents (EES) for ULMCA stenosis between 2009 and 2010. The 18-month incidence rates of major adverse cardiac or cerebrovascular events (MACCE), including death, myocardial infarction (MI), stroke, or ischemia-driven target vessel revascularization (TVR), were compared with those of a randomized study comparing patients who received sirolimus-eluting stents (SES) (n = 327) or coronary artery bypass grafts (CABG) (n = 272). Results: EES (8.9%) showed a comparable incidence of MACCE as SES (10.8%; adjusted hazard ratio [aHR] of EES: 0.84; 95% confidence interval [CI]: 0.51 to 1.40; p = 0.51) and CABG (6.7%, aHR of EES: 1.40; 95% CI: 0.78 to 2.54; p = 0.26). The composite incidence of death, MI, or stroke also did not differ among patients receiving EES (3.3%), SES (3.7%; aHR of EES: 0.63; 95% CI: 0.27 to 1.47; p = 0.29), and CABG (4.8%; aHR of EES: 0.67; 95% CI: 0.29 to 1.54; p = 0.34). However, the incidence of ischemia-driven TVR in the EES group (6.5%) was higher than in the CABG group (2.6%, aHR of EES: 2.77; 95% CI: 1.17 to 6.58; p = 0.02), but comparable to SES (8.2%, aHR of EES: 1.14; 95% CI: 0.64 to 2.06; p = 0.65). Angiographic restenosis rates were similar in the SES and EES groups (13.8% vs. 9.2%, p = 0.16). Conclusions: Second-generation EES had a similar 18-month risk of MACCE for ULMCA stenosis as first-generation SES or CABG. (Evaluation of Outcomes of EES Implantation for Unprotected Left Main Coronary Artery Stenosis [PRECOMBAT-2]; NCT01348022)

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DO - 10.1016/j.jcin.2012.05.002

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EP - 717

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

SN - 1936-8798

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