Kei Yamamoto; Takao Sato; Hanan Salem; Yu-Wei Chen; Mitsuaki Matsumura; Nikolas Bletnitsky; Khady  N. Fall; Megha Prasad; Vivian  G. Ng; Sanjum  S. Sethi; Tamim Nazif; Sahil  A. Parikh; Torsten  P. Vahl; Ziad  A. Ali; Dimitri Karmpaliotis; LeRoy  E. Rabbani; Michael  B. Collins; Martin  B. Leon; Margaret McEntegart; Jeffery  W. Moses; Ajay  J. Kirtane; Gary  S. Mintz; Akiko Maehara

doi:10.4244/EIJ-D-23-00406

Ostial right coronary artery lesion morphology and outcomes after treatment with drug-eluting stents

Kei Yamamoto¹^,², MD; Takao Sato¹^,², MD; Hanan Salem¹^,²^,³, MD; Yu-Wei Chen¹^,², MD; Mitsuaki Matsumura², BS; Nikolas Bletnitsky¹, BS; Khady N. Fall¹, MD, MPH; Megha Prasad¹, MD, MS; Vivian G. Ng¹, MD; Sanjum S. Sethi¹, MD; Tamim M. Nazif¹^,², MD; Sahil A. Parikh¹^,², MD; Torsten P. Vahl¹^,², MD; Ziad A. Ali²^,⁴, MD, DPhil; Dimitri Karmpaliotis²^,⁵, MD, PhD; LeRoy E. Rabbani¹^,², MD; Michael B. Collins¹, MD; Martin B. Leon¹^,², MD; Margaret McEntegart¹^,², MD, PhD; Jeffery W. Moses¹^,²^,⁴, MD; Ajay J. Kirtane¹^,², MD, SM; Gary S. Mintz², MD; Akiko Maehara¹^,², MD

Abstract

BACKGROUND: Outcomes after percutaneous coronary intervention (PCI) for de novo ostial right coronary artery (RCA) lesions are poor.

AIMS: We used intravascular ultrasound (IVUS) to clarify the morphological patterns of de novo ostial RCA lesions and their associated clinical outcome.

METHODS: Among 5,102 RCA IVUS studies, 170 de novo ostial RCA stenoses (within 3 mm from the aorto-ostium) were identified. These were classified as 1) isolated ostial lesions (no disease extending beyond 10 mm from the ostium and without a calcified nodule [CN]); 2) ostial CN, typically with diffuse disease (disease extending beyond 10 mm); and 3) ostial lesions with diffuse disease but without a CN. The primary outcome was target lesion failure (TLF: cardiac death, target vessel myocardial infarction, definite stent thrombosis, and ischaemia-driven target lesion revascularisation).

RESULTS: The prevalence of an isolated ostial lesion was 11.8% (n=20), 47.6% (n=81) were ostial CN, and 40.6% (n=69) were ostial lesions with diffuse disease. Compared to ostial lesions with diffuse disease, isolated lesions were more common in women (75.0% vs 42.0%; p=0.01), and CN were associated with older age...

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