1. The value of DES in unprotected left main lesions has not been evaluated by dedicated randomized clinical trials. Especially, it is not known whether currently available DES show different performance when used to treat left main lesions. Intracoronary Stenting and Angiographic Results: Drug-Eluting Stents for Unprotected Coronary Left Main Lesions ISAR-LEFT MAIN J. Mehilli, MD Deutsches Herzzentrum & 1. Klink rechts der Isar, Technische Universität Munich, Germany Potential differences in safety and efficacy between DES types may be important when treating unprotected left main lesions.

2. Aim of the ISAR-LEFT MAIN study was to assess the relative efficacy of the paclitaxel-eluting stent (Taxus) and sirolimus-eluting stent (Cypher) in patients with unprotected LMCA lesions. Included: Patients with symptomatic more than 50 % blockage located in left main vessel Excluded: Cardiogenic shock ST-elevation acute myocardial infarction In-stent restenosis Prior coronary artery bypass surgery Left main size >4.5 mm by visual estimation Malignancies with life expectancy <1 year Intracoronary Stenting and Angiographic Results: Drug-Eluting Stents for Unprotected Coronary Left Main Lesions

3. End Points and Population Primary End Point: combined incidence of death, myocardial infarction and revascularization at 1 year Secondary End Point: Angiographic restenosis at follow-up angiogram Paclitaxel-eluting stent (Taxus) n=302 Sirolimus-eluting stent (Cypher) n=305 607 patients Clopidogrel 600 mg + Aspirin 500mg i.v. Clopidogrel 75 mg/day & ASS 200mg/day indefinitely Both groups well matched: 69 y old 30% diabetics 40% ACS 25% prior MI 50% prior PCI 70% multivessel CAD 63% distal lesions 50% culotte stenting

4. % Death/MI/ Revascularization P=NS 1 Year Clinical Outcomes

5. 0 10 20 30 40 50 012 Y RR 0.99 (95% CI, 0.69-1.42), P=.96 Patients at Risk Cypher305270251197175 Cypher Taxus Cumulative Incidence, % Taxus302278250189160 Death, Myocardial Infarction or Reintervention - 2-Year Follow-Up -

6. Summary Treatment of unprotected LMCA lesions in unselected patients with DES is feasible, safe and effective up to two years; Both Taxus and Cypher stents provide similar clinical and angiographic outcomes in this form of coronary artery disease.