title: Sirolimus-eluting stent implantation for ostial right coronary artery lesions: five-year outcomes from the j-Cypher registry.
abstract: Ostial right coronary artery (RCA) lesions are associated with a high restenosis rate after bare-metal stent implantation. However, long-term outcomes after drug-eluting stent (DES) implantation for ostial RCA lesions have not been adequately evaluated. Among 12824 patients enrolled in the j-Cypher registry, 5-year outcomes were compared between 397 patients with ostial RCA lesions, and 3716 patients with non-ostial RCA lesions treated with sirolimus-eluting stents (SES). Through 5-year follow-up, patients with ostial RCA lesions had a significantly higher cumulative incidence of target lesion revascularization (TLR) (28.2 versus 13.7 %, P < 0.0001) than those with non-ostial RCA lesions. After adjusting for confounders, excess TLR risk of the ostial group relative to the non-ostial group was significant for both early TLR within 1-year and late TLR beyond 1-year (HR 2.14 [95 % CI 1.59-2.84], P < 0.0001, and HR 1.58 [95 % CI 1.06-2.26], P = 0.02, respectively). Although the cumulative incidence of death was also significantly higher in the ostial group than in the non-ostial group (25.7 versus 14.4 %, P < 0.0001), the excess risk of the ostial group relative to the non-ostial group was no longer significant after adjusting for confounders (HR 1.25 [95 % CI 0.99-1.57], P = 0.07). SES implantation for ostial RCA lesions was associated with higher risk for TLR as compared with that for non-ostial RCA lesions. Restenosis, both early and late, remains an issue in coronary DES implantation for ostial RCA lesions.
authors.affiliation: Japanese Red Cross Society Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
authors.forename: Euihong
authors.initials: E
authors.lastname: Ko
authors.forename: Masahiro
authors.initials: M
authors.lastname: Natsuaki
authors.forename: Mamoru
authors.initials: M
authors.lastname: Toyofuku
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Matsumura
authors.forename: Maki
authors.initials: M
authors.lastname: Oi
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Motohashi
authors.forename: Kousuke
authors.initials: K
authors.lastname: Takahashi
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kawase
authors.forename: Mariko
authors.initials: M
authors.lastname: Tanaka
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kitada
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Yuzuki
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamura
authors.forename: Katsumi
authors.initials: K
authors.lastname: Inoue
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000517:prevention & control; D023903:Coronary Restenosis / Q000517:prevention & control; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D020123:Sirolimus