title: Acute and long-term outcomes of intracoronary stenting in aorto-ostial, left anterior descending artery-ostial and nonostial stenoses.
abstract: Percutaneous transluminal coronary angioplasty in ostial lesions is technically difficult and is associated with a lower procedural success rate, higher complication rate and restenosis rate as compared to nonostial lesions. The safety, feasibility, immediate and 6-month angiographic, and long-term clinical outcomes of stenting in aorto-ostial, left anterior descending artery (LAD)-ostial and nonostial stenoses, were retrospectively compared in 19 patients with 20 aorto-ostial lesions (group A), 97 with 97 LAD-ostial lesions (group B) and 1778 with 2242 nonostial lesions (group C). The major adverse cardiac events during hospitalization were similar among the three groups (p = 0.816). Twelve patients with 12 lesions in group A, 75 with 75 lesions in group B and 1384 with 1749 lesions in group C underwent a 6-month follow-up coronary angiography. There were no differences in acute gain (2.04 +/- 0.46 vs. 2.34 +/- 0.50 vs. 2.39 +/- 0.54 mm, respectively, p = 0.057) and net gain (0.89 +/- 1.02 vs. 1.26 +/- 1.08 vs. 1.34 +/- 0.76 mm, respectively, p = 0.105) among the three groups. Group B had a larger late loss than group A and C (1.15 +/- 1.01 vs. 1.22 +/- 0.76 vs. 1.04 +/- 0.65 mm, respectively, p = 0.048) and group A had a larger loss index than group B and C (0.59 +/- 0.50 vs. 0.52 +/- 0.31 vs. 0.48 +/- 0.29, respectively, p = 0.027). The binary restenosis rate among the three groups was 33%, 29% and 20%, respectively, (p = 0.072). Group B had higher restenotic rate as compared to group C (p = 0.036). During a long-term follow-up period of 42+/-21 months, major adverse cardiac events were similar among the three groups (15.8% vs. 25.8% vs. 20.1%, respectively, p = 0.362), but group B had a higher incidence of recurrent angina as compared to group C (17.5% vs. 10.9%, p = 0.039). The cardiac event-free survival rate, as determined by Kaplan-Meier analysis, was similar among the three groups (56% vs. 57% vs. 67%, respectively, p = 0.149); a borderline significance was noted as compared group B to group C (p = 0.051). In conclusion, stenting in aorto-ostial or LAD-ostial lesions is safe, feasible and has a similar acute result as compared to stenting in nonostial lesions; however, it still has a higher 6-month angiographic restenosis rate. LAD-ostial stenoses may have a less favorable long-term clinical outcome than nonostial stenoses.
authors.affiliation: Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan.
authors.forename: Hsuan-Li
authors.initials: HL
authors.lastname: Huang
authors.forename: I-Chang
authors.initials: IC
authors.lastname: Hsieh
authors.forename: Shang-Hung
authors.initials: SH
authors.lastname: Chang
authors.forename: Hern-Jia
authors.initials: HJ
authors.lastname: Chang
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Chen
authors.forename: Kuo-Chun
authors.initials: KC
authors.lastname: Hung
authors.forename: Ming-Shien
authors.initials: MS
authors.lastname: Wen
authors.forename: Delon
authors.initials: D
authors.lastname: Wu
mesh_terms: D000208:Acute Disease; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003331:Coronary Vessels / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012189:Retrospective Studies; D012449:Safety; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome