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 SeongSeung Jung Park

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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

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Kim, Y. H., Park, D. W., Ahn, J. M., Yun, S. C., Song, H. G., Lee, J. Y., Kim, W. J., Kang, S. J., Lee, S. W., Lee, C. W., Park, S. W., Jang, Y., Jeong, M. H., Kim, H. S., Hur, S. H., Rha, S. W., Lim, D. S., Her, S. H., Seung, K. B., ... Park, S. J. (2012). 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. JACC: Cardiovascular Interventions, 5(7), 708-717. https://doi.org/10.1016/j.jcin.2012.05.002