Acute and long-term outcomes of drug-eluting stent implantations in aorto-ostial, left anterior descending artery-ostial, and nonostial lesions

Background This study was designed to evaluate the acute and long-term clinical and angiographic outcomes of drug-eluting stent (DES) implantations in aorto-ostial, left anterior descending artery (LAD)-ostial and nonostial lesions. Method From the CAPTAIN (cardiovascular atherosclerosis and percutaneous transluminal interventions) registry, a total of 61 patients with 61 aorto-ostial, 173 patients with 173 LAD-ostial, and 1,954 patients with 2,391 nonostial lesions were treated with DES implantations. Results Compared to patients with LAD-ostial and nonostial lesions, those with aorto-ostial lesions had a larger late loss (0.43 ± 0.66, 0.42 ± 0.63, and 0.95 ± 0.93 mm, respectively, P = 0.001), higher loss index (0.18 ± 0.28, 0.18 ± 0.26, and 0.39 ± 0.38, respectively, P = 0.001), and restenosis rate (7%, 6%, and 25%, respectively, P < 0.001) at a 6-9 months angiographic follow-up. During the long-term follow-up period of 34 ± 26 months, the aorto-ostial group had a higher rate of target vessel failure (21.7% vs. 12.3% vs. 10.9%, respectively, P = 0.030) and a lower cardiovascular event-free survival rate, as determined by the Kaplan-Meier analysis, than the other two groups (P = 0.002). Conclusions In spite of treatment with DES implantation, aorto-ostial stenosis is still associated with higher restenosis and lower cardiovascular event-free survival rates than LAD-ostial and nonostial lesions during a long-term follow-up; however, LAD-ostial stenoses are not associated with a higher risk than nonostial lesions.