Long-Term Results Support DES Versus BMS for Unprotected Left Main Coronary Stenting

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 to 1.40; P = .976) or myocardial infarction (14.3% vs 14.9%; HR, 0.83; 95% CI, 0.49 to 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 to 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 to 0.78; P = .009) or nonbifurcation (3.4% vs 10.3%; HR, 0.39; 95% CI, 0.17 to 0.88; P = .024) lesions with a comparable risk of death or myocardial infarction.