A study published online in February in the Journal of the American College of Cardiology concluded that the implantation of either paclitaxel or sirolimus-eluting stents in unprotected left main coronary artery lesions is safe and effective.
According to the researchers, both of these stents provide comparable clinical and angiographic outcomes. Results of the ISAR-LEFT MAIN trial were reported at the Transcatheter Cardiovascular Therapeutics meeting last year by Dr Julinda Mehilli, Deutsches Herzzentrum, Munich, Germany.
In this randomised study, 607 patients with symptomatic coronary artery disease undergoing percutaneous coronary intervention for unprotected left main coronary artery were enrolled: 302 were assigned to receive Taxus paclitaxel-eluting stent (Boston Scientific) and 305 assigned to receive Cypher sirolimus-eluting stent (Cordis). The primary endpoint was the combined incidence of death, myocardial infarction, and target lesion revascularisation at one year. The secondary endpoint was angiographic restenosis on the basis of the left main coronary artery area analysis at follow-up angiography.
At one year the cumulative incidence of death, myocardial infarction, or target lesion revascularisation was 13.6% in the Taxus group and 15.8% in the Cypher group (p=.44). One patient in the Taxus group (.3%) and two patients in the Cypher group (.7%) experienced definite stent thrombosis (p=.57). Mortality at two years was 10.7% in the Taxus and 8.7% in the Cypher group (p=.64). Angiographic restenosis was 16% with Taxus and 19.4% with Cypher stents (p=.30).