• Mamoru Toyofuku, Takeshi Kimura, Takeshi Morimoto, Yasuhiko Hayashi, Nobuo Shiode, Hideo Nishikawa, Koichi Nakao, Kinya Shirota, Kazuya Kawai, Yoshikazu Hiasa, Kazushige Kadota, Yoichi Nozaki, Takaaki Isshiki, Takahito Sone, Kazuaki Mitsudo, and j-Cypher Registry Investigators.
• Wakayama Medical Center, Wakayama, Japan.
• JACC Cardiovasc Interv. 2013 Jul 1; 6 (7): 654-63.

ObjectivesThis study assessed 5-year outcomes after implantation of sirolimus-eluting stents (SES) for unprotected left main coronary artery (ULMCA) disease in comparison with that for non-left main disease.BackgroundMore information on long-term outcomes after ULMCA stenting is needed.MethodsThe j-Cypher is a multicenter prospective registry of consecutive patients undergoing SES implantation in Japan.ResultsAmong 12,812 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 5 years was significantly higher in patients with ULMCA stenting than in patients without ULMCA stenting (22.8% vs. 14.1%; p < 0.0001); however, the risk for death with ULMCA stenting was no longer significant after adjusting for confounders (hazard ratio: 1.18, 95% confidence interval: 0.95 to 1.46; p = 0.14). In the lesion-level comparison, the nonbifurcation ULMCA lesions treated exclusively with SES had a significantly lower rate of target lesion revascularization (TLR) than those in non-ULMCA nonbifurcation lesions (2.4% vs. 12.7%; p = 0.04). Among bifurcation lesions, those treated with a provisional 2-stent approach had similar rates of TLR (12.1% vs. 11.4%; p = 0.79) between the ULMCA and non-ULMCA groups. Lesions treated with an elective 2-stent approach had higher TLR rates in the ULMCA group as compared with the non-ULMCA group (33.5% vs. 19.7%; p = 0.002).ConclusionsThe safety of ULMCA stenting relative to non-LMCA stenting was maintained through 5 years follow-up. In terms of efficacy, SES implantation in nonbifurcation ULMCA lesions was associated with an extremely low cumulative incidence of TLR, whereas the elective 2-stent approach for ULMCA bifurcation lesions was associated with a markedly higher cumulative incidence of TLR as compared with that for non-ULMCA bifurcation lesions.Copyright © 2013. Published by Elsevier Inc.

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