{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T12:15:41Z","timestamp":1775909741335,"version":"3.50.1"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2009,11,10]]},"abstract":"<jats:p>\n            <jats:bold>\n              <jats:italic>Background\u2014<\/jats:italic>\n            <\/jats:bold>\n            Long-term outcomes after stenting of an unprotected left main coronary artery (ULMCA) with drug-eluting stents have not been addressed adequately despite the growing popularity of this procedure.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Methods and Results\u2014<\/jats:italic>\n            <\/jats:bold>\n            j-Cypher is a multicenter prospective registry of consecutive patients undergoing sirolimus-eluting stent implantation in Japan. Among 12 824 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 3 years was significantly higher in patients with ULMCA stenting (n=582) than in patients without ULMCA stenting (n=12 242; 14.6% versus 9.2%, respectively;\n            <jats:italic>P<\/jats:italic>\n            &lt;0.0001); however, there was no significant difference between the 2 groups in the adjusted risk of death (hazard ratio 1.23, 95% confidence interval 0.95 to 1.60,\n            <jats:italic>P<\/jats:italic>\n            =0.12). Among 476 patients whose ULMCA lesions were treated exclusively with a sirolimus-eluting stent, patients with ostial\/shaft lesions (n=96) compared with those with bifurcation lesions (n=380) had a significantly lower rate of target-lesion revascularization for the ULMCA lesions (3.6% versus 17.1%,\n            <jats:italic>P<\/jats:italic>\n            =0.005), with similar cardiac death rates at 3 years (9.8% versus 7.6%,\n            <jats:italic>P<\/jats:italic>\n            =0.41). Among patients with bifurcation lesions, patients with stenting of both the main and side branches (n=119) had significantly higher rates of cardiac death (12.2% versus 5.5%;\n            <jats:italic>P<\/jats:italic>\n            =0.02) and target-lesion revascularization (30.9% versus 11.1%;\n            <jats:italic>P<\/jats:italic>\n            &lt;0.0001) than those with main-branch stenting alone (n=261).\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Conclusions\u2014<\/jats:italic>\n            <\/jats:bold>\n            The higher unadjusted mortality rate of patients undergoing ULMCA stenting with a sirolimus-eluting stent did not appear to be related to ULMCA treatment itself but rather to the patients\u2019 high-risk profile. Although long-term outcomes in patients with ostial\/shaft ULMCA lesions were favorable, outcomes in patients with bifurcation lesions treated with stenting of both the main and side branches appeared unacceptable.\n          <\/jats:p>","DOI":"10.1161\/circulationaha.109.873349","type":"journal-article","created":{"date-parts":[[2009,10,27]],"date-time":"2009-10-27T01:46:49Z","timestamp":1256608009000},"page":"1866-1874","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":92,"title":["Three-Year Outcomes After Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease"],"prefix":"10.1161","volume":"120","author":[{"given":"Mamoru","family":"Toyofuku","sequence":"first","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Kimura","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Morimoto","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhiko","family":"Hayashi","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Ueda","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuya","family":"Kawai","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoichi","family":"Nozaki","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinichi","family":"Hiramatsu","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Miura","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiaki","family":"Yokoi","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinichiro","family":"Toyoshima","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitoshi","family":"Nakashima","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuo","family":"Haze","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaru","family":"Tanaka","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunsuke","family":"Take","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeru","family":"Saito","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takaaki","family":"Isshiki","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuaki","family":"Mitsudo","sequence":"additional","affiliation":[{"name":"From Tsuchiya General Hospital (M. Toyofuku, Y.H., H.U.), Hiroshima, Japan; Department of Cardiovascular of Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Chikamori Hospital (K.K.), Kochi, Japan; Hokko Memorial Hospital (Y.N.), Sapporo, Japan; Ehime Prefectural Central Hospital (S.H.), Matsuyama, Japan; Japanese Red Cross Society Wakayama Medical Center (A.M.), Wakayama, Japan; Kishiwada Tokushukai..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000155256.88940.f8"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.10.039"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60314-6"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.108.808311"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10157-006-0453-4"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200104123441502"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.106.685313"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.12.1494"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.91.9.2325"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.105.595694"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0801441"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0804626"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.10.009"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2006.05.015"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.107.185102"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn270"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.03.020"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.107.692178"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.12.015"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.12.051"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1214\/aos\/1176350951"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.109.873349","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:17:03Z","timestamp":1715581023000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.109.873349"}},"subtitle":["Insights From the j-Cypher Registry"],"short-title":[],"issued":{"date-parts":[[2009,11,10]]},"references-count":21,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2009,11,10]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.109.873349"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.109.873349","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,11,10]]},"assertion":[{"value":"2009-10-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}