Sirolimus-eluting stent implantation for treatment of proximal left anterior descending coronary artery lesions: Long-term outcome and predictors of adverse cardiac events

Objectives: Acute and long-term results after sirolimus-eluting stent (SES) implantation of proximal left anterior descending coronary artery (LAD) disease were evaluated. Background: Although SES has been used increasingly for the treatment of LAD disease, data regarding their safety and efficacy in a real-world population are limited. Methods: We investigate the short- and long-term results in 966 patients who underwent SES implantation for stenosis of proximal LAD. Results: The procedural success rate was 97.6%, and procedural non-Q-wave myocardial infarction (MI) rate was 14.5%. In-hospital major complications occurred in five patients (0.5%), including three deaths and two Q-wave MIs. During follow-up (20.4 ± 8.9 months), there were 16 deaths (1.7%; 10 cardiac, 6 noncardiac), 2 Q-wave MIs, and 22 target lesion revascularizations (2.3%). Late stent thrombosis occurred in two patients (0.2%), 14 and 23 months after the procedure. The event-free survival rates for cardiac death/Q-wave MI were 98.6% ± 0.4% at 1 year and 97.8% ± 0.6% at 2 years. The cumulative probabilities of survival without major adverse cardiac events (MACE) were 96.7% ± 0.6% at 1 year and 95.4% ± 0.8% at 2 years. In multivariate analysis, stented length (HR 1.04, 95%CI 1.01-1.07, P = 0.009) and infarct-related artery (HR 5.18, 95%CI 1.09-24.64, P = 0.039) were independently related to cardiac death/Q-wave MI. In addition, stented length (HR 1.04, 95%CI 1.02-1.06, P < 0.001) and left ventricular dysfunction (HR 2.66, 95%CI 1.07-6.63, P = 0.036) were significant independent predictors of MACE. Conclusions: SES implantation for proximal LAD disease appears safe and effective in a real-world population, and the independent predictors of MACE included stented length and left ventricular dysfunction.