2nd generation drug-eluting stents intended for left main coronary artery

Original title: Zotarolimus- versus Everolimus-Eluting Stents for Unprotected Left Main Coronary Artery Disease. ISAR-LEFT MAIN 2 Study. Reference: Julinda Mehilli et al. J Am Coll Cardiol, article in press.

Improvements in 2nd generation drug-eluting stents led to increased efficiency and safety , however there is little information on these new platforms to treat left main coronary artery .

This study compared two permanent polymer drug-eluting stents, Resolute zotarolimus – eluting stent ( ZES , Medtronic CardioVascular , Santa Rosa , California ) and Xience everolimus – eluting stent (EES, Abbott Vascular Devices , Santa Clara , California ) in a population selected relatively coursing de novo injury of unprotected trunk left main coronary artery ≥ 50 % and symptoms or evidence of myocardial ischemia.

Primary endpoint of the study was a composite of death , myocardial infarction and revascularization at one year and in the secondary year , incidence of definite stent thrombosis / probable and incidence of binary restenosis at follow-up angiography . Between 2007 and 2011 a total of 650 patients with unprotected left main coronary artery were randomized to angioplasty using ZES vs. EES . The proportion of patients with high surgical risk was similar in both groups ( 37 % versus 35.3 %, P = 0.7 ) as well as the distal trunk involvement ( 83 % versus 76.8 %, P = .13 ) . The predominant technique was a single stent and treat other injuries was allowed ( 34 % versus 30 %, p = 0.25 ) using the same type of stent in the trunk .   Both had identical incidence of definite thrombosis ( 0.6 % ) there was a single patient with probable thrombosis in ZES branch . The incidence of the primary combined end point was 17.5 % in the ZES group versus 14.3 % in the EES group , this difference of 3.2 % did not reach statistical significance. In patients who received 2 stents to treat bifurcation the combined end point was 22.7 % versus 13 % in those receiving only one ( RR 1.86 , 95 % CI 1.26 to 2.74 ) . There was no interaction between the type of stent and the technique used in the bifurcation.

Angiographic follow up at an average of 203 days were available for 73.1% of patients receiving ZES and for 69.3% of the EES . The incidence of binary restenosis ( ≥ 50 % by quantitative angiography ) was not different between the two stents ( ZES 21.5 %  versus EES 16.8 %, P = 0.24 ).

Conclusion :

Both 2nd generation  drug eluting stents showed angiographic and clinical results comparable at one year to treat unprotected left main coronary artery in a population relatively unselected. 

Editorial comment:

The minor cuantity of events was less than expected and impacted negativelly on the statistical power of the study that only reached a power of 57 % for the non-inferiority margin . Although this does not seems to be important, no differences between the two platforms to treat left main coronary artery are noticeable. Angiographic follow up in 70% of the population and the definition of TLR as any new revascularization procedure for segment without requiring clinical symptoms or signs of ischemia probably exaggerated revascularization incidence.

SOLACI.ORG

More articles by this author

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Andromeda Trial: Meta-Analysis of Drug Coated Balloon vs. DES in Small Vessel DeNovo Lesions

The use of coronary stents vs plain old balloon angioplasty (POBA), has allowed to reduce recoil and limiting flow dissection which were major limitation...

QFR vs. FFR: Is Coronary Revascularization Deferral Safe? Results from a FAVOR III Sub-Analysis

In cases of intermediate coronary lesions, functional assessment is recommended to aid the decision-making process regarding revascularization. There are several tools currently used to...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...