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Recently, stent implantation for ostial left anterior descending coronary artery (LAD) lesions has become a common clinical practice; however, the efficacy and safety of LAD ostial stenting (OS) and distal left main coronary artery (LMCA) to LAD crossover stenting (CS) is not well known.
A total of 118 consecutive patients underwent percutaneous coronary intervention (PCI) for ostial LAD lesions in our hospital from 2012 to 2015. Ostial lesion was defined as a stenosis located within 5mm of the vessel origin. Those ostial LAD lesions with concomitant LMCA distal lesions were excluded from this analysis. All patients were treated with second-generation drug-eluting stent (DES) and IVUS guidance. We examined two year outcomes in ostial LAD lesions treated with OS (n=67) and CS (n=51) retrospectively.
There were no significant differences in baseline characteristics. The two-year major adverse cardiac events (MACE) rate was not significantly different between OS and CS group (6.0% vs. 2.0%, p=0.27). MACE defined as a composite of cardiac death, myocardial infarction (MI), stent thrombosis (ST) and clinical driven target lesion revascularization (TLR). Moreover there were no significant differences in other outcomes (cardiac death 0% vs. 2.0%, p=0.30; MI 0% vs. 0%; ST 0% vs. 0%; TLR 6.0% vs. 0%, p=0.07).
In the second-generation DES era, there were similar outcomes in LAD ostial stenting and distal LMCA to LAD crossover stenting. This data support LAD ostial stenting is acceptable strategy for ostial LAD lesions.
CORONARY: PCI Outcomes