Original Research

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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Volume 20 Number 3
Feb 5, 2024
Volume 20 Number 3
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