title: Sirolimus-eluting stent implantation for ostial left anterior descending coronary artery lesions: three-year outcome from the j-Cypher Registry.
abstract: BACKGROUND
  Ostial left anterior descending coronary artery (LAD) lesion has been regarded as a lesion subset unsuitable for coronary stenting. Long-term outcomes of sirolimus-eluting stent (SES) implantation for ostial LAD lesions have not been adequately evaluated.
  
  
  RESULTS
  Among 12 824 patients enrolled in the j-Cypher Registry, 3-year outcomes were compared between 481 patients with SES-treated ostial LAD lesions and 5369 patients with SES-treated nonostial proximal LAD lesions. Patients with ostial LAD lesions had similar incidences of target lesion revascularization (TLR) as those with nonostial proximal LAD lesions (9.4% versus 9.7%; P=0.98; adjusted hazard ratio [HR], 0.99; 95% CI, 0.7 to 1.36; P=0.94) and death/myocardial infarction (MI) (10.7% versus 11.4%; P=0.82; adjusted HR, 1.05; 95% CI, 0.76 to 1.4; P=0.77). Among the patients with ostial LAD lesions, those undergoing both main and side branch stenting (n=62) compared to main branch stenting alone (n=419) had a higher risk for TLR (adjusted HR, 4.65; 95% CI, 2.32 to 9.25; P<0.0001) but similar risk for death/MI (adjusted HR, 1.15; 95% CI, 0.49 to 2.41; P=0.73). In patients with main branch stenting alone, outcomes after crossover stenting across the circumflex coronary artery (n=225) were not different from those after ostial stenting (n=194) for TLR (adjusted HR, 0.77; 95% CI, 0.33 to 1.82; P=0.55) and for death/MI (adjusted HR, 1.54; 95% CI, 0.78 to 3.2; P=0.22).
  
  
  CONCLUSIONS
  In terms of both safety and efficacy, 3-year outcomes of percutaneous coronary intervention using SES for ostial LAD lesions were comparable to those for nonostial proximal LAD lesions. Crossover stenting with a 1-stent approach might be a reasonable option in treating ostial LAD lesions.
authors.affiliation: Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kishi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Masanobu
authors.initials: M
authors.lastname: Namura
authors.forename: Toshiya
authors.initials: T
authors.lastname: Muramatsu
authors.forename: Hideo
authors.initials: H
authors.lastname: Nishikawa
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Takaaki
authors.initials: T
authors.lastname: Isshiki
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Nobuyoshi
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D003331:Coronary Vessels / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D012008:Recurrence; D012042:Registries; D012306:Risk; D020123:Sirolimus / Q000008:administration & dosage*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D020123:Sirolimus