Acute and long-term outcomes of drug-eluting stent implantations in aorto-ostial, left anterior descending artery-ostial, and nonostial lesions

• Published in: Catheterization and cardiovascular interventions 2013-11, Vol.82 (5), p.727-734
• Main Authors: Hsieh, I-Chang, Chen, Chun-Chi, Chang, Shang-Hung, Hsieh, Ming-Jer, Wang, Chao-Yung, Lee, Cheng-Hung, Lin, Fen-Chiung
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - instrumentation; Angioplasty, Balloon, Coronary - mortality; aorto-ostial lesion; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronary Restenosis - etiology; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - mortality; Coronary Stenosis - therapy; Disease-Free Survival; drug-eluting stent; Drug-Eluting Stents; Female; Humans; Kaplan-Meier Estimate; left anterior descending artery-ostial lesion; Male; Middle Aged; ostial lesion; Registries; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.24943

Background This study was designed to evaluate the acute and long‐term clinical and angiographic outcomes of drug‐eluting stent (DES) implantations in aorto‐ostial, left anterior descending artery (LAD)‐ostial and nonostial lesions. Method From the CAPTAIN (cardiovascular atherosclerosis and percutaneous transluminal interventions) registry, a total of 61 patients with 61 aorto‐ostial, 173 patients with 173 LAD‐ostial, and 1,954 patients with 2,391 nonostial lesions were treated with DES implantations. Results Compared to patients with LAD‐ostial and nonostial lesions, those with aorto‐ostial lesions had a larger late loss (0.43 ± 0.66, 0.42 ± 0.63, and 0.95 ± 0.93 mm, respectively, P = 0.001), higher loss index (0.18 ± 0.28, 0.18 ± 0.26, and 0.39 ± 0.38, respectively, P = 0.001), and restenosis rate (7%, 6%, and 25%, respectively, P < 0.001) at a 6–9 months angiographic follow‐up. During the long‐term follow‐up period of 34 ± 26 months, the aorto‐ostial group had a higher rate of target vessel failure (21.7% vs. 12.3% vs. 10.9%, respectively, P = 0.030) and a lower cardiovascular event‐free survival rate, as determined by the Kaplan‐Meier analysis, than the other two groups (P = 0.002). Conclusions In spite of treatment with DES implantation, aorto‐ostial stenosis is still associated with higher restenosis and lower cardiovascular event‐free survival rates than LAD‐ostial and nonostial lesions during a long‐term follow‐up; however, LAD‐ostial stenoses are not associated with a higher risk than nonostial lesions.© 2013 Wiley Periodicals, Inc.