title: Long-term outcomes after drug-eluting stent for the treatment of ostial left anterior descending coronary artery lesions.
abstract: BACKGROUND
  Although drug-eluting stents (DES) have reduced restenosis in a broad range of lesions, there is limited data, from relatively small studies, on the safety and efficacy of DES for isolated ostial left anterior descending (LAD) stenoses. In addition, in the setting of these high-risk lesions, there is the issue of the potential involvement of the left main (LM) bifurcation, requiring subsequent revascularization for a lesion involving this critical location.
  
  
  METHODS
  Patients with a de novo isolated unprotected ostial LAD stenoses treated with DES were included. Evaluated end points were cardiac death, nonfatal myocardial infarction, overall target lesion revascularization (TLR), and the reintervention for a restenotic lesion located at the LM segment adjacent to the stent (TLR-LM).
  
  
  RESULTS
  A total of 162 patients were included: 95 underwent focal ostial LAD stenting and 67 stenting from the distal LM into the LAD ostium. The 2-year Kaplan-Meier estimates of cardiac death, nonfatal myocardial infarction, overall TLR, and TLR-LM were 2.6%, 2.1%, 8.3%, and 4.7%, respectively. Overall TLR and TLR-LM rates were higher in the focal ostial LAD stenting group. There was a trend toward an independent increased risk of TLR associated with focal ostial stenting. In addition, final minimal luminal diameter trended to be independently associated with TLR.
  
  
  CONCLUSIONS
  The present study showed that DES for isolated ostial LAD lesions is a feasible, safe, and effective treatment strategy. In addition, this study suggested the hypothesis that a default distal LM-LAD stenting, rather than focal ostial stenting, might provide more favorable outcomes. Nevertheless, larger specifically designed studies are needed.
authors.affiliation: Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy. pcapranzano@gmail.com
authors.forename: Piera
authors.initials: P
authors.lastname: Capranzano
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sanfilippo
authors.forename: Francesco
authors.initials: F
authors.lastname: Tagliareni
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Sergio
authors.initials: S
authors.lastname: Monaco
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
authors.forename: Arturo
authors.initials: A
authors.lastname: Giordano
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D002423:Cause of Death; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors