Author + information
- Satoru Mitomo1,
- Richard Jabbour2,
- Antonio Mangieri3,
- Marco Ancona3,
- Damiano Regazzoli3,
- Akihiro Nakajima4,
- Toru Naganuma4,
- Francesco Giannini3,
- Azeem Latib3,
- Sunao Nakamura4 and
- Antonio Colombo5
- 1IRCCS San Raffaele Scientific Institute, Milan, Milan, Italy
- 2Imperial College London, London, United Kingdom
- 3Interventional Cardiology Institute San Raffaele Hospital, Milan, Milan, Italy
- 4New Tokyo Hospital, Matsudo, Japan
- 5Interventional Cardiology Institute San Raffaele Hospital - Stamford Hospital - Columbia University - Centro Cuore Columbus, Milan, Milan, Italy
The studies comparing clinical outcomes after early (E-) and new (N-) drug-eluting stents (DES) implantation for right coronary artery (RCA) aorto-ostial (AO) lesions are limited. The aim of this study was to evaluate clinical outcomes after treatment of RCA AO lesions with E- and new N- generation DES.
From January 2005 to December 2013, a total of 334 de novo RCA AO lesions treated with DES (E- :142 lesions, N-: 192 lesions) at 2 high-volume centers (Italy and Japan) were included in this study after excluding cases of in-stent restenosis, those treated with balloon angioplasty alone or bare metal stent, or cases without follow-up. An AO lesion was defined as a lesion located within 3mm from the aortic orifice. The primary endpoint was target lesion failure (TLF) defined as composite of cardiac mortality, target vessel myocardial infarction, and target lesion revascularization (TLR).
Baseline characteristics were well balanced between the 2 groups. There were no significant differences regarding type of lesion stenosis between the two groups (focal / diffuse / chronic total occlusion; p=0.42). The size of the stents deployed (3.35±0.37mm vs 3.39±0.33mm, p=0.29) and non-compliant balloon size used for post-dilatation (3.55±0.38mm vs 3.62±0.47mm, p=0.21) were similar between the two groups. The median follow-up period was 1309 (IQR: 702-1753) days. The cumulative rate of TLF at 3 years was significantly higher in E-DES group when compared with N-DES group (38.3% vs 18.1 %, p<0.001), which was mainly driven by TLR (38.4% vs 11.6%, p<0.001). Multivariable analysis using Cox-regression analysis revealed that N-DES [HR 0.20 (0.11-0.34), p<0.001], stent underexpansion [HR 12.06 (7.02-20.73), p<0.001], excessive aortic stent protrusion [HR 4.32 (2.58-7.23), p<0.001], and proximal stent overlap [HR 2.03 (1.22-3.37), p<0.01] were independent predictors of TLR.
For the treatment of RCA AO lesions, N-DES were associated with a lower incidence of TLF at 3 years when compared with E-DES, which was mainly driven by a lower rate of TLR. N-DES use and certain suboptimal stenting characteristics were independent predictors of TLR.
CORONARY: Stents: Drug-Eluting