title: Clinical outcome of patients with implantation of second-generation drug-eluting stents in the right coronary ostium: insights from 2-year follow-up of the TWENTE trial.
abstract: OBJECTIVE
  The aim of the present study was to assess the impact on clinical outcome of right coronary artery (RCA) ostial coverage with second-generation drug-eluting stents (DES).
  
  
  BACKGROUND
  Treatment of the aorta-ostial (AO) region of the RCA with bare metal stents and first-generation DES has been associated with a higher risk of target-lesion revascularization (TLR).
  
  
  METHODS
  Of the 1,391 patients of the prospective TWENTE trial, we identified 321 (23%) with single-vessel RCA treatment, who were categorized into stenting with AO stent coverage (AOC) versus stenting without AOC. The AO region was defined as 3 mm from the aortic orifice.
  
  
  RESULTS
  The 67 (20.9%) patients with AOC showed more severe lesion calcifications than the 254 patients without AOC (31.3% vs. 12.6%; P < 0.01). In the AOC group, there was a higher prevalence of hypercholesterolemia and family history of coronary disease (75.4% vs. 61.6%, and 68.7% vs. 53.5%, respectively; P = 0.03). During 2-year follow-up, patients in the AOC group had a higher incidence of TLR (7.5% vs. 1.6%; P = 0.02). Following adjustment for confounders, AOC independently predicted TLR with an adjusted hazard ratio of 4.1 (95% CI: 1.17-14.39; P = 0.03).
  
  
  CONCLUSIONS
  AO treatment of the RCA with second-generation DES is feasible, but our data suggest that stent coverage of the right AO segment remains a predictor of TLR.
authors.affiliation: Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands.
authors.forename: Ming Kai
authors.initials: MK
authors.lastname: Lam
authors.forename: Hanim
authors.initials: H
authors.lastname: Sen
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tandjung
authors.forename: Marije M
authors.initials: MM
authors.lastname: Löwik
authors.forename: Mounir W Z
authors.initials: MW
authors.lastname: Basalus
authors.forename: Janne C
authors.initials: JC
authors.lastname: Mewes
authors.forename: Martin G
authors.initials: MG
authors.lastname: Stoel
authors.forename: K Gert
authors.initials: KG
authors.lastname: van Houwelingen
authors.forename: Gerard C M
authors.initials: GC
authors.lastname: Linssen
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Ijzerman
authors.forename: Carine J M
authors.initials: CJ
authors.lastname: Doggen
authors.forename: Clemens
authors.initials: C
authors.lastname: von Birgelen
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000175:diagnosis / Q000628:therapy
keywords: aorta-ostial lesion; drug-eluting stent; ostium; revascularization; right coronary artery