Acute and long-term outcomes of intracoronary stenting in aorto-ostial, left anterior descending artery-ostial and nonostial stenoses

Percutaneous transluminal coronary angioplasty in ostial lesions is technically difficult and is associated with a lower procedural success rate, higher complication rate and restenosis rate as compared to nonostial lesions. The safety, feasibility, immediate and 6-month angiographic, and long-term clinical outcomes of stenting in aorto-ostial, left anterior descending artery (LAD)-ostial and nonostial stenoses, were retrospectively compared in 19 patients with 20 aorto-ostial lesions (group A), 97 with 97 LAD-ostial lesions (group B) and 1778 with 2242 nonostial lesions (group C). The major adverse cardiac events during hospitalization were similar among the three groups (p=0.816). Twelve patients with 12 lesions in group A, 75 with 75 lesions in group B and 1384 with 1749 lesions in group C underwent a 6-month follow-up coronary angiography. There were no differences in acute gain (2.04±0.46 vs. 2.34±0.50 vs. 2.39±0.54 mm, respectively, p=0.057) and net gain (0.89±1.02 vs. 1.26±1.08 vs. 1.34±0.76 mm, respectively, p=0.105) among the three groups. Group B had a larger late loss than group A and C (1.15±1.01 vs. 1.22±0.76 vs. 1.04±0.65 mm, respectively, p=0.048) and group A had a larger loss index than group B and C (0.59±0.50 vs. 0.52±0.31 vs. 0.48±0.29, respectively, p=0.027). The binary restenosis rate among the three groups was 33%, 29% and 20%, respectively, (p=0.072). Group B had higher restenotic rate as compared to group C (p=0.036). During a long-term follow-up period of 42±21 months, major adverse cardiac events were similar among the three groups (15.8% vs. 25.8% vs. 20.1%, respectively, p=0.362), but group B had a higher incidence of recurrent angina as compared to group C (17.5% vs. 10.9%, p=0.039). The cardiac event-free survival rate, as determined by Kaplan-Meier analysis, was similar among the three groups (56% vs. 57% vs. 67%, respectively, p=0.149); a borderline significance was noted as compared group B to group C (p=0.051). In conclusion, stenting in aorto-ostial or LAD-ostial lesions is safe, feasible and has a similar acute result as compared to stenting in nonostial lesions; however, it still has a higher 6-month angiographic restenosis rate. LAD-ostial stenoses may have a less favorable long-term clinical outcome than nonostial stenoses.