Long-Term MAIN-COMPARE Data Support DES Versus BMS

August 4, 2009—In Circulation, Young-Hak Kim, MD, et al for the MAIN-COMPARE investigators have published findings on the long-term safety and effectiveness of unprotected left main coronary stenting with drug-eluting stents (DES) compared with bare-metal stents (BMS) (2009;120:400–407). The investigators concluded that compared with BMS, DES was associated with a reduction in the need for repeat revascularization without increasing the risk of death or myocardial infarction for patients with unprotected left main coronary artery stenosis.

According to the investigators, limited information is available on long-term outcomes for patients with unprotected left main coronary artery disease who received DES. In the MAIN-COMPARE multicenter registry evaluating outcomes among patients with unprotected left main coronary artery stenosis undergoing stenting with either BMS or DES, 1,217 consecutive patients were divided into two groups: 353 who received only BMS and 864 who received at least one DES. The

3-year outcomes were compared by use of the adjustment of inverse-probability-of-treatment-weighted method. Patients receiving DES were older and had a higher prevalence of diabetes mellitus, hypertension, hyperlipidemia, and multivessel disease.

The investigators reported that in the overall population, with the use of DES, the 3-year adjusted risk of death (8% vs 9.5%; hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.36–1.40; P = .976) or myocardial infarction (14.3% vs 14.9%; HR, 0.83; 95% CI, 0.49–1.40;

P = .479) was similar compared with BMS. However, the risk of target lesion revascularization was significantly lower with the use of DES than BMS (5.4% vs 12.1%; HR, 0.4; 95% CI, 0.22–0.73; P = .003). When patients were classified according to lesion location, DES were still associated with lower risk of target lesion revascularization in patients with bifurcation (6.9% vs 16.3%; HR, 0.38; 95% CI, 0.18–0.78; P = .009) or nonbifurcation (3.4% vs 10.3%; HR, 0.39; 95% CI, 0.17–0.88; P = .024) lesions with a comparable risk of death or myocardial infarction.

Correction: In the June/July issue, on page 30, an incorrect sentence read: "The ideal newer DES platforms will ut thinner struts to enhance these acute stent performance characteristics." The sentence should have read: "The ideal newer DES platforms will utilize thinner struts to enhance these acute stent performance characteristics." The corrected version appears on our Web site.

Additionally, in Table 1 on page 33, the units of measure for the Polymer Thickness and Strut Thickness column should have been µm. Also, the Vestasync polymer thickness should have been 0.6, and the strut thickness should have been 65 µm. The corrected version of this table is available on our Web site. We apologize for any confusion these errors may have caused.