• Julinda Mehilli, Gert Richardt, Marco Valgimigli, Stefanie Schulz, Ambika Singh, Mohamed Abdel-Wahab, Klaus Tiroch, Jürgen Pache, Jörg Hausleiter, Robert A Byrne, Ilka Ott, Tareq Ibrahim, Massimiliano Fusaro, Melchior Seyfarth, Karl-Ludwig Laugwitz, Steffen Massberg, Adnan Kastrati, and ISAR-LEFT-MAIN 2 Study Investigators.
• Klinikum der Universität Munich, Ludwig-Maximilian University, Munich, Germany. Electronic address: julinda.mehilli@med.uni-muenchen.de.
• J. Am. Coll. Cardiol. 2013 Dec 3; 62 (22): 2075-82.

ObjectivesThis study sought to compare the safety and efficacy of the zotarolimus-eluting stent (ZES) and the everolimus-eluting stent (EES) for treatment of unprotected left main coronary artery (uLMCA) disease.BackgroundThe second-generation ZES and EES have reduced the risk of restenosis in large patient cohorts. However, their comparative performance in uLMCA lesions is not known.MethodsIn this study, patients with symptomatic coronary artery disease undergoing percutaneous coronary intervention for uLMCA lesions were randomly assigned to receive either a ZES (n = 324) or an EES (n = 326). The primary endpoint was the combined incidence of death, myocardial infarction, and target lesion revascularization at 1 year. Secondary endpoints were definite or probable stent thrombosis at 1 year and angiographic restenosis based on analysis of the left main coronary artery area at follow-up angiography.ResultsAt 1 year, the cumulative incidence of the primary endpoint was 17.5% in the ZES group and 14.3% in the EES group (relative risk: 1.26; 95% confidence interval [CI]: 0.85 to 1.85; p = 0.25). Three patients in the ZES group (0.9%) and 2 patients in the EES group (0.6%) experienced definite or probable stent thrombosis (p > 0.99). All-cause mortality at 1 year was equal in the 2 groups (5.6%; relative risk: 1.00; 95% CI: 0.52 to 1.93; p = 0.98). Angiographic restenosis occurred in 21.5% of patients in the ZES group and 16.8% in the EES group (relative risk: 1.28; 95% CI: 0.86 to 1.92; p = 0.24).ConclusionsWithin the statistical limitations of the present study, treatment of uLMCA lesions with a ZES or an EES provided comparable clinical and angiographic outcomes at 1-year follow-up.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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