P5581Self-expandable sirolimus-eluting stents for the treatment of the unprotected left main: propensity score-matched comparison with second generation drug-eluting stents

Abstract

Background: Sirolimus‐eluting, self‐expandable Stentys stents (SES) may represent a valuable option for the treatment of the unprotected left main (ULM). In conditions where the choice of the appropriate stent‐size may prove challenging, particularly in the presence of relevant caliber variations from the ULM to the side branches, SES may offer some advantages over conventional second‐generation drug‐eluting stents (DES‐II). However, scarce data are available regarding the safety and effectiveness of SES in the treatment of ULM, in particular no studies compared SES and DES in this setting are available. Purpose: Aim of the present study is to assess the clinical outcomes of patients with ULM stenosis treated with SES compared to DES‐II. Methods: Patients were included from two multicentre, international registries, one including patients with coronary stenoses treated with SES and the other patients with ULM stenoses treated with DES‐II. To account for potential confounders and the lack of randomization, a propensity‐score with matching was computed. The primary end‐point of the present analysis was the rate of major adverse cardiovascular events (MACE, a composite end‐point including all cause death, myocardial infarction [MI], target lesion revascularization [TLR], unstable angina and stent thrombosis [ST]). Secondary end‐points were the single components of MACE. Results: Out of the two registries, 151 patients treated with SES and 1270 with DES‐II were included. The crude rate of MACE at 250 days did not differ between the two groups (9.8% vs. 11.5%, P=0.54). After propensity score with a 1:2 matching, 129 patients with SES and 258 with DES‐II were selected. Baseline features of the matched groups were similar, particularly in terms of age (mean 70 years in SES group vs. 71 in DES‐II group, P=0.45), female gender (33% vs. 33%, P=0.91), cardiovascular risk factors, clinical indication for PCI (stable angina 36% vs. 49%, P=0.66) and Syntax score (23 vs. 24, P=0.65). After a median followup of 250 days, a similar MACE rate was reported for SES and DES‐II patients (9.9% vs. 8.5%, p=0.66), as well as a similar rate of ST. MI was more frequent in the SES group (2.3% vs. 0%, P=0.030), but this difference was apparently not driven by device‐related MI, as the rate of ST (0.8% vs. 1.2%) and TLR of the ULM (1.6% vs. 3.1%, p=0.36) was similar between the two study groups. A subanalysis for ULM bifurcations treated with provisional vs. 2‐stent strategy did not show differences between SES and DES‐II. Conclusion: SES may represent a safe and effective option for the treatment of ULM, particularly when a relevant calibre gap is observed from the ULM to the side branches. Patients with ULM stenoses treated with SES reported a similar rate of MACE at 250 days compared to patients treated with DES‐II.