ISSN: 1885-5857 Impact factor 2023 7.2
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Original article
Ten-year clinical outcomes after left main coronary artery stenting with new-generation or early-generation DES

Resultados clínicos a 10 años tras el implante de SLF de primera o nueva generación en el tronco coronario izquierdo

Jens WiebeabConstantin KunaaTareq IbrahimcSebastian KufneraIsabella HintzaPaul JustenhovenaThorsten KesslerabHeribert SchunkertabMarco ValgimiglidGert RichardteJola BreshacKarl-Ludwig LaugwitzbcAdnan KastratiabSalvatore Cassesea

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10.1016/j.rec.2025.02.003
Abstract
Introduction and objectives

Long-term data after stenting of the left main coronary artery (LMCA) are scarce, especially regarding new-generation drug-eluting stents (DES). This analysis aimed to describe the 10-year clinical outcomes of patients who underwent percutaneous coronary intervention with different DES generations for LMCA disease.

Methods

Individual patient data from the randomized controlled ISAR-LEFT MAIN and ISAR-LEFT MAIN 2 trials were pooled and 10-year clinical follow-up was obtained. The Kaplan-Meier method was used to calculate event rates. The main endpoints of interest for this analysis were all-cause mortality, myocardial infarction, target lesion revascularization and definite stent thrombosis.

Results

A total of 1257 patients were included in this analysis, of which 650 patients were treated with new-generation DES and 607 with early-generation DES. At 10 years, the mortality rate was more than 40% in both groups. After statistical adjustment, 10-year mortality was significantly reduced in patients treated with new-generation DES compared with those treated with early-generation DES (HRadj, 0.78; 95%CI, 0.62-0.97). After 10 years, the risk of myocardial infarction (HRadj, 0.43; 95%CI, 0.23-0.80), target lesion revascularization (HRadj, 0.66; 95%CI, 0.49-0.89), and definite stent thrombosis (HRadj, 0.13, 95%CI, 0.04-0.49) was significantly reduced by new-generation DES compared with early-generation DES.

Conclusions

Patients undergoing percutaneous coronary intervention for LMCA disease have high 10-year mortality regardless of DES generation. The use of new-generation DES in patients with LMCA disease is associated with improved long-term clinical outcomes compared with early-generation DES.

Keywords

Left main coronary artery
Drug-eluting stent
Percutaneous coronary intervention
Long-term outcome

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