Sirolimus-eluting stent implantation for treatment of proximal left anterior descending coronary artery lesions: long-term outcome and predictors of adverse cardiac events.

Abstract

OBJECTIVES:

Acute and long-term results after sirolimus-eluting stent (SES) implantation of proximal left anterior descending coronary artery (LAD) disease were evaluated.

BACKGROUND:

Although SES has been used increasingly for the treatment of LAD disease, data regarding their safety and efficacy in a real-world population are limited.

METHODS:

We investigate the short- and long-term results in 966 patients who underwent SES implantation for stenosis of proximal LAD.

RESULTS:

The procedural success rate was 97.6%, and procedural non-Q-wave myocardial infarction (MI) rate was 14.5%. In-hospital major complications occurred in five patients (0.5%), including three deaths and two Q-wave MIs. During follow-up (20.4 +/- 8.9 months), there were 16 deaths (1.7%; 10 cardiac, 6 noncardiac), 2 Q-wave MIs, and 22 target lesion revascularizations (2.3%). Late stent thrombosis occurred in two patients (0.2%), 14 and 23 months after the procedure. The event-free survival rates for cardiac death/Q-wave MI were 98.6% +/- 0.4% at 1 year and 97.8% +/- 0.6% at 2 years. The cumulative probabilities of survival without major adverse cardiac events (MACE) were 96.7% +/- 0.6% at 1 year and 95.4% +/- 0.8% at 2 years. In multivariate analysis, stented length (HR 1.04, 95%CI 1.01-1.07, P = 0.009) and infarct-related artery (HR 5.18, 95%CI 1.09-24.64, P = 0.039) were independently related to cardiac death/Q-wave MI. In addition, stented length (HR 1.04, 95%CI 1.02-1.06, P < 0.001) and left ventricular dysfunction (HR 2.66, 95%CI 1.07-6.63, P = 0.036) were significant independent predictors of MACE.

CONCLUSIONS:

SES implantation for proximal LAD disease appears safe and effective in a real-world population, and the independent predictors of MACE included stented length and left ventricular dysfunction.

• Authors: Cheol Whan Lee, Chong-Hiok Tan, Jon Suh, Se-Whan Lee, Duk-Woo Park, Seung-Whan Lee, Young-Hak Kim, Myeong-Ki Hong, Jae-Joong Kim, Seong-Wook Park, Seung-Jung Park
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 70 Issue 3 Pg. 368-73 (Sep 2007) ISSN: 1522-1946 [Print] United States
• PMID: 17722041 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: (c) 2007 Wiley-Liss, Inc.

Chemical References

• Coated Materials, Biocompatible
• Immunosuppressive Agents
• Sirolimus

Topics

• Adult
• Aged
• Aged, 80 and over
• Blood Vessel Prosthesis Implantation (instrumentation)
• Coated Materials, Biocompatible
• Coronary Angiography
• Coronary Disease (diagnostic imaging, surgery)
• Electrocardiography
• Female
• Follow-Up Studies
• Humans
• Immunosuppressive Agents (pharmacology)
• Male
• Middle Aged
• Myocardial Revascularization (methods)
• Postoperative Complications
• Prognosis
• Retrospective Studies
• Sirolimus (pharmacology)
• Stents
• Time Factors