Elsevier

The American Journal of Cardiology

Volume 135, 15 November 2020, Pages 62-67
The American Journal of Cardiology

Procedural Outcomes of Patients Undergoing Percutaneous Coronary Intervention for De Novo Lesions in the Ostial and Proximal Left Circumflex Coronary Artery

https://doi.org/10.1016/j.amjcard.2020.08.014Get rights and content

Highlights

  • Ostial lesions can be challenging during percutaneous coronary intervention (PCI).

  • We assessed PCI outcomes of ostial left circumflex artery (LC).

  • PCI of ostial LC had higher rates of major adverse cardiovascular events (MACE).

  • Mainly, higher mortality rates drove these higher MACE rates.

  • Among tested covariates, dialysis had the highest impact on MACE rate.

Ostial coronary artery lesions can be challenging during percutaneous coronary intervention (PCI) because of elastic fiber content, calcium burden, and angulation. We assessed procedural and clinical major adverse cardiac events (MACE) associated with PCI for ostial lesions, focusing on ostial left circumflex (LC) lesions compared with ostial left anterior descending artery (LAD) and right coronary artery lesions. All patients with ostial or very proximal coronary artery lesions treated with PCI at MedStar Washington Hospital Center (Washington, DC) from 2003 to 2018 were included. The primary end point was target lesion revascularization (TLR)-MACE, defined as the composite of all-cause mortality, Q-wave myocardial infarction (MI), and TLR at 1 year. A total of 4,759 patients with available 1-year follow-up were included: 2,236 ostial/very proximal LAD, 980 ostial/very proximal LC, and 1,543 ostial/very proximal right. The presenting clinical syndrome for the LC group was mainly stable or unstable angina, whereas MI was more common in the LAD. At 1 year, the TLR-MACE rate was 16.7% in the LC group versus 12.5% in the LAD and 11.8% in the right group (p = 0.001). Mortality rates were 11.2% in the LC group versus 8.4% in the LAD and 6% in the right group (p <0.001). A Cox model showed that dialysis had the highest impact on TLR-MACE. In conclusion, compared with PCI of ostial or very proximal LAD or right lesions, PCI of ostial or very proximal LC lesions was associated with higher rates of TLR-MACE.

Section snippets

Methods

All patients with ostial/very proximal coronary artery lesions treated with PCI at MedStar Washington Hospital Center (Washington, DC) from 2003 to 2018 were included in this analysis. In the current analysis, the definition of an ostial lesion was extended to include the segment immediately beyond the ostium. Patients with PCI of at least 1 ostial lesion and with at least 1 year of available follow-up were included in the analysis. Patients who underwent stenting for distal LMCA lesions in

Results

A total of 4,759 patients with available 1-year follow-up had PCI for ostial/proximal lesions and were included in this analysis: 2,236 LAD, 980 LC, and 1,543 right. The age of this cohort was 66 ± 26 years, and 64.8% were men. A history of hypertension, DM, hypercholesterolemia, MI, PCI, coronary artery bypass surgery, peripheral arterial disease, congestive heart failure, or CRI was more common in the LC group. The clinical presentation for the LC group was mainly stable or unstable angina,

Discussion

The main findings from our study are as follows: (1) Patients who underwent PCI for an ostial or very proximal LC lesion had a higher prevalence of comorbid conditions, including a history of previous MI and coronary interventions, DM, and chronic kidney disease. (2) At 1-year follow-up, TLR-MACE was higher in the LC (16.7%) than in the right and LAD (11.8% and 12.5%, respectively, p <0.001), driven mainly by higher mortality rates in the LC group. (3) Among tested covariates, dialysis had the

Author Contribution

Anees Musallam: Conceptualization, Formal analysis, Writing original draft, Writing (review and editing).

Chava Chezar-Azerrad: Conceptualization, Methodology, Validation, Formal analysis, Writing (review and editing).

Rebecca Torguson: Conceptualization, Methodology, Validation, Formal analysis, Writing (review and editing).

Brian C. Case: Conceptualization, Formal analysis, Writing (review and editing).

Charan Yerasi: Conceptualization, Formal analysis, Writing (review and editing).

Brian J.

Disclosures

Toby Rogers—Consultant and proctor: Medtronic, Edwards Lifesciences; Advisory board: Medtronic. Equity interest: Transmural Systems. Ron Waksman—Advisory Board: Amgen, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.; Consultant: Amgen, Biotronik, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.; Grant support: AstraZeneca, Biotronik, Boston Scientific, Chiesi; Speakers Bureau: AstraZeneca, Chiesi;

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Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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