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Ostial right coronary artery (RCA) lesion has been regarded as a difficult subset associated with suboptimal outcome after percutaneous coronary intervention (PCI). However, long–term outcomes after sirolimus–eluting stent (SES) implantation for ostial RCA lesions have not been adequately evaluated.
Among 12824 consecutive patients enrolled in the j–Cypher Registry, 5–year outcomes were compared between 397 patients with SES–treated ostial RCA lesions and 5369 patients with SES–treated non–ostial proximal RCA lesions. Multivariable analysis was performed to evaluate the independent risk factors of target lesion revascularization (TLR) after SES implantation for ostial RCA lesions.
Through 5–year follow–up, patients with ostial RCA lesions had significantly higher cumulative incidence of TLR (28.2% versus 13.7%, P<0.0001; adjusted hazard ratio [HR] 1.94 [95%CI 1.54–2.42], P<0.0001) and death/myocardial infarction (MI) (28.1% versus 16.8%, P<0.0001; adjusted HR 1.29 [95%CI 1.03–1.61], P=0.03) compared to those with non–ostial proximal RCA lesions. Cumulative incidence of TLR within the first year was significantly higher in patients with ostial RCA lesions compared to those with non–ostial RCA lesions (17.5% versus 6.1%, P<0.0001; adjusted HR 2.16 [95%CI 1.60–2.87], P<0.0001). Cumulative incidence of late TLR (1–year to 5–year) was also significantly higher in patients with ostial RCA lesions than in those with non–ostial RCA lesions (13.0% versus 8.1%, P=0.006; adjusted HR 1.59 [95%CI 1.07–2.29], P=0.02). Multivariable analysis identified several independent risk factors for TLR of ostial RCA lesions: hemodialysis, severe calcification, in–stent restenosis and small reference diameter at pre–procedure (< 2.5mm).
In terms of both safety and efficacy, PCI using SES for ostial RCA lesions were challenging as compared with those for non–ostial proximal RCA lesions.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.–10:45 a.m.
Session Title: Coronary Stents
Abstract Category: 47. TCT@ACC–i2: Coronary Intervention, Devices
Presentation Number: 2101–247
- 2013 American College of Cardiology Foundation