Outcomes after percutaneous coronary intervention of ostial lesions in the era of drug-eluting stents

Melanie Freeman; David Clark; Nick Andrianopoulos; Stephen Duffy; Han Lim; A Brennan; Kerrie Charter; James Shaw; M Horrigan; A Ajani; M Sebastian; Christopher Reid; H.M.Omar Farouque; A Walton; Catherine Farrington; R Gunaratne; Archer Broughton; Jay Federman; Craig Keighley; Anthony Dart; Jennifer Johns; L Oliver; Joy Brennan; Robert Chan; George Proimos; T Dortimer; B Chan; Andrew Tonkin; Louise Brown; N Campbell; A Sahar; G New; Louise Roberts; Houng Bang Liew; Michael Rowe; N Cheong; Christopher Goods; R Lew; G Szto; R Templin; A Black; Thomas Yip; L Ponnuthrai; M Rahmen; Jessica Dyson; T Duplessis; Henry Krum; A Meehan; Phillipa Loane; L Curran; F Groen; R Warren; David Eccleston; J Lefkovits; B Yan; Probal Roy; Sharad Shetty; Ronen Gurvitch; Yean Lim; Antony Walton

Outcomes after percutaneous coronary intervention of ostial lesions in the era of drug-eluting stents

Melanie Freeman, David Clark, Nick Andrianopoulos, Stephen Duffy, Han Lim, A Brennan, Kerrie Charter, James Shaw, M Horrigan, A Ajani, M Sebastian, Christopher Reid, H.M.Omar Farouque, A Walton, Catherine Farrington, R Gunaratne, Archer Broughton, Jay Federman, Craig Keighley, Anthony DartJennifer Johns, L Oliver, Joy Brennan, Robert Chan, George Proimos, T Dortimer, B Chan, Andrew Tonkin, Louise Brown, N Campbell, A Sahar, G New, Louise Roberts, Houng Bang Liew, Michael Rowe, N Cheong, Christopher Goods, R Lew, G Szto, R Templin, A Black, Thomas Yip, L Ponnuthrai, M Rahmen, Jessica Dyson, T Duplessis, Henry Krum, A Meehan, Phillipa Loane, L Curran, F Groen, R Warren, David Eccleston, J Lefkovits, B Yan, Probal Roy, Sharad Shetty, Ronen Gurvitch, Yean Lim, Antony Walton

Research output: Contribution to journal › Article › peer-review

24 Citations (Scopus)

Abstract

Background:
Ostial lesions are a difficult subset associated with suboptimal outcomes after percutaneous coronary intervention (PCI). The aim of this study was to analyze outcomes of ostial lesions in contemporary Australian interventional practice.

Methods:
The study population comprised 1,713 consecutive patients who underwent PCI for proximal lesions of the left anterior descending, left circumflex, and right coronary arteries, who were prospectively enrolled in the Melbourne Interventional Group Registry (February 2004–December 2006). We compared the in-hospital, 30-day, and 1-year outcomes of the 109 patients undergoing PCI for ostial, with the 1,604 patients with proximal nonostial lesions. Left main and bifurcation lesions were excluded.

Results:
Patients in the ostial group were older (mean age 68.8 ± 11 vs. 64.9 ± 12 years; P = 0.001), and there was a greater proportion of women (38.5% vs. 28.0%; P = 0.021). Other clinical characteristics were similar. The nonostial group were more likely receive a stent (94.6% vs. 87.2%; P = 0.005) but drug-eluting stents (DES) were deployed more often in the ostial group (47.9% vs. 66.1%; P < 0.0001). There was lower procedural success, with no significant difference in in-hospital death, bleeding or emergency PCI, but unplanned in-hospital coronary artery bypass grafting was more frequent in the ostial group (4.8% vs. 1.0%; P = 0.007). There was no difference in 30-day major adverse cardiac events. However, 12-month death (8.8% vs. 4%, log rank P = 0.032) and MACE (24.2% vs. 13.8%, log rank P = 0.005) were higher in the ostial group than the nonostial group with trends to increased incidence of myocardial infarction (6.6% vs. 4.7%, P = NS), and target vessel revascularization (13.2% vs. 7.9%, P = NS).

Conclusion:
In contemporary, Australian interventional practice, PCI for ostial lesions is associated with a high incidence of adverse outcome at one year despite the introduction of DES. © 2008 Wiley-Liss, Inc.

Original language	English
Pages (from-to)	763-768
Number of pages	6
Journal	Catheterization and Cardiovascular Interventions
Volume	73
Issue number	6
Early online date	16 Dec 2008
Publication status	Published - 1 May 2009

Cite this

Freeman, M., Clark, D., Andrianopoulos, N., Duffy, S., Lim, H., Brennan, A., Charter, K., Shaw, J., Horrigan, M., Ajani, A., Sebastian, M., Reid, C., Farouque, H. M. O., Walton, A., Farrington, C., Gunaratne, R., Broughton, A., Federman, J., Keighley, C., ... Walton, A. (2009). Outcomes after percutaneous coronary intervention of ostial lesions in the era of drug-eluting stents. Catheterization and Cardiovascular Interventions, 73(6), 763-768.

@article{f09aaf20db5743329f213f295e05e1d4,

title = "Outcomes after percutaneous coronary intervention of ostial lesions in the era of drug-eluting stents",

abstract = "Background:Ostial lesions are a difficult subset associated with suboptimal outcomes after percutaneous coronary intervention (PCI). The aim of this study was to analyze outcomes of ostial lesions in contemporary Australian interventional practice.Methods:The study population comprised 1,713 consecutive patients who underwent PCI for proximal lesions of the left anterior descending, left circumflex, and right coronary arteries, who were prospectively enrolled in the Melbourne Interventional Group Registry (February 2004–December 2006). We compared the in-hospital, 30-day, and 1-year outcomes of the 109 patients undergoing PCI for ostial, with the 1,604 patients with proximal nonostial lesions. Left main and bifurcation lesions were excluded.Results:Patients in the ostial group were older (mean age 68.8 ± 11 vs. 64.9 ± 12 years; P = 0.001), and there was a greater proportion of women (38.5% vs. 28.0%; P = 0.021). Other clinical characteristics were similar. The nonostial group were more likely receive a stent (94.6% vs. 87.2%; P = 0.005) but drug-eluting stents (DES) were deployed more often in the ostial group (47.9% vs. 66.1%; P < 0.0001). There was lower procedural success, with no significant difference in in-hospital death, bleeding or emergency PCI, but unplanned in-hospital coronary artery bypass grafting was more frequent in the ostial group (4.8% vs. 1.0%; P = 0.007). There was no difference in 30-day major adverse cardiac events. However, 12-month death (8.8% vs. 4%, log rank P = 0.032) and MACE (24.2% vs. 13.8%, log rank P = 0.005) were higher in the ostial group than the nonostial group with trends to increased incidence of myocardial infarction (6.6% vs. 4.7%, P = NS), and target vessel revascularization (13.2% vs. 7.9%, P = NS).Conclusion:In contemporary, Australian interventional practice, PCI for ostial lesions is associated with a high incidence of adverse outcome at one year despite the introduction of DES. {\textcopyright} 2008 Wiley-Liss, Inc.",

author = "Melanie Freeman and David Clark and Nick Andrianopoulos and Stephen Duffy and Han Lim and A Brennan and Kerrie Charter and James Shaw and M Horrigan and A Ajani and M Sebastian and Christopher Reid and H.M.Omar Farouque and A Walton and Catherine Farrington and R Gunaratne and Archer Broughton and Jay Federman and Craig Keighley and Anthony Dart and Jennifer Johns and L Oliver and Joy Brennan and Robert Chan and George Proimos and T Dortimer and B Chan and Andrew Tonkin and Louise Brown and N Campbell and A Sahar and G New and Louise Roberts and Liew, {Houng Bang} and Michael Rowe and N Cheong and Christopher Goods and R Lew and G Szto and R Templin and A Black and Thomas Yip and L Ponnuthrai and M Rahmen and Jessica Dyson and T Duplessis and Henry Krum and A Meehan and Phillipa Loane and L Curran and F Groen and R Warren and David Eccleston and J Lefkovits and B Yan and Probal Roy and Sharad Shetty and Ronen Gurvitch and Yean Lim and Antony Walton",

year = "2009",

month = may,

day = "1",

language = "English",

volume = "73",

pages = "763--768",

journal = "Catheterization and Cardiovascular Interventions",

issn = "1522-1946",

number = "6",

}

Freeman, M, Clark, D, Andrianopoulos, N, Duffy, S, Lim, H, Brennan, A, Charter, K, Shaw, J, Horrigan, M, Ajani, A, Sebastian, M, Reid, C, Farouque, HMO, Walton, A, Farrington, C, Gunaratne, R, Broughton, A, Federman, J, Keighley, C, Dart, A, Johns, J, Oliver, L, Brennan, J, Chan, R, Proimos, G, Dortimer, T, Chan, B, Tonkin, A, Brown, L, Campbell, N, Sahar, A, New, G, Roberts, L, Liew, HB, Rowe, M, Cheong, N, Goods, C, Lew, R, Szto, G, Templin, R, Black, A, Yip, T, Ponnuthrai, L, Rahmen, M, Dyson, J, Duplessis, T, Krum, H, Meehan, A, Loane, P, Curran, L, Groen, F, Warren, R, Eccleston, D, Lefkovits, J, Yan, B, Roy, P, Shetty, S, Gurvitch, R, Lim, Y & Walton, A 2009, 'Outcomes after percutaneous coronary intervention of ostial lesions in the era of drug-eluting stents', Catheterization and Cardiovascular Interventions, vol. 73, no. 6, pp. 763-768.

TY - JOUR

T1 - Outcomes after percutaneous coronary intervention of ostial lesions in the era of drug-eluting stents

AU - Freeman, Melanie

AU - Clark, David

AU - Andrianopoulos, Nick

AU - Duffy, Stephen

AU - Lim, Han

AU - Brennan, A

AU - Charter, Kerrie

AU - Shaw, James

AU - Horrigan, M

AU - Ajani, A

AU - Sebastian, M

AU - Reid, Christopher

AU - Farouque, H.M.Omar

AU - Walton, A

AU - Farrington, Catherine

AU - Gunaratne, R

AU - Broughton, Archer

AU - Federman, Jay

AU - Keighley, Craig

AU - Dart, Anthony

AU - Johns, Jennifer

AU - Oliver, L

AU - Brennan, Joy

AU - Chan, Robert

AU - Proimos, George

AU - Dortimer, T

AU - Chan, B

AU - Tonkin, Andrew

AU - Brown, Louise

AU - Campbell, N

AU - Sahar, A

AU - New, G

AU - Roberts, Louise

AU - Liew, Houng Bang

AU - Rowe, Michael

AU - Cheong, N

AU - Goods, Christopher

AU - Lew, R

AU - Szto, G

AU - Templin, R

AU - Black, A

AU - Yip, Thomas

AU - Ponnuthrai, L

AU - Rahmen, M

AU - Dyson, Jessica

AU - Duplessis, T

AU - Krum, Henry

AU - Meehan, A

AU - Loane, Phillipa

AU - Curran, L

AU - Groen, F

AU - Warren, R

AU - Eccleston, David

AU - Lefkovits, J

AU - Yan, B

AU - Roy, Probal

AU - Shetty, Sharad

AU - Gurvitch, Ronen

AU - Lim, Yean

AU - Walton, Antony

PY - 2009/5/1

Y1 - 2009/5/1

N2 - Background:Ostial lesions are a difficult subset associated with suboptimal outcomes after percutaneous coronary intervention (PCI). The aim of this study was to analyze outcomes of ostial lesions in contemporary Australian interventional practice.Methods:The study population comprised 1,713 consecutive patients who underwent PCI for proximal lesions of the left anterior descending, left circumflex, and right coronary arteries, who were prospectively enrolled in the Melbourne Interventional Group Registry (February 2004–December 2006). We compared the in-hospital, 30-day, and 1-year outcomes of the 109 patients undergoing PCI for ostial, with the 1,604 patients with proximal nonostial lesions. Left main and bifurcation lesions were excluded.Results:Patients in the ostial group were older (mean age 68.8 ± 11 vs. 64.9 ± 12 years; P = 0.001), and there was a greater proportion of women (38.5% vs. 28.0%; P = 0.021). Other clinical characteristics were similar. The nonostial group were more likely receive a stent (94.6% vs. 87.2%; P = 0.005) but drug-eluting stents (DES) were deployed more often in the ostial group (47.9% vs. 66.1%; P < 0.0001). There was lower procedural success, with no significant difference in in-hospital death, bleeding or emergency PCI, but unplanned in-hospital coronary artery bypass grafting was more frequent in the ostial group (4.8% vs. 1.0%; P = 0.007). There was no difference in 30-day major adverse cardiac events. However, 12-month death (8.8% vs. 4%, log rank P = 0.032) and MACE (24.2% vs. 13.8%, log rank P = 0.005) were higher in the ostial group than the nonostial group with trends to increased incidence of myocardial infarction (6.6% vs. 4.7%, P = NS), and target vessel revascularization (13.2% vs. 7.9%, P = NS).Conclusion:In contemporary, Australian interventional practice, PCI for ostial lesions is associated with a high incidence of adverse outcome at one year despite the introduction of DES. © 2008 Wiley-Liss, Inc.

AB - Background:Ostial lesions are a difficult subset associated with suboptimal outcomes after percutaneous coronary intervention (PCI). The aim of this study was to analyze outcomes of ostial lesions in contemporary Australian interventional practice.Methods:The study population comprised 1,713 consecutive patients who underwent PCI for proximal lesions of the left anterior descending, left circumflex, and right coronary arteries, who were prospectively enrolled in the Melbourne Interventional Group Registry (February 2004–December 2006). We compared the in-hospital, 30-day, and 1-year outcomes of the 109 patients undergoing PCI for ostial, with the 1,604 patients with proximal nonostial lesions. Left main and bifurcation lesions were excluded.Results:Patients in the ostial group were older (mean age 68.8 ± 11 vs. 64.9 ± 12 years; P = 0.001), and there was a greater proportion of women (38.5% vs. 28.0%; P = 0.021). Other clinical characteristics were similar. The nonostial group were more likely receive a stent (94.6% vs. 87.2%; P = 0.005) but drug-eluting stents (DES) were deployed more often in the ostial group (47.9% vs. 66.1%; P < 0.0001). There was lower procedural success, with no significant difference in in-hospital death, bleeding or emergency PCI, but unplanned in-hospital coronary artery bypass grafting was more frequent in the ostial group (4.8% vs. 1.0%; P = 0.007). There was no difference in 30-day major adverse cardiac events. However, 12-month death (8.8% vs. 4%, log rank P = 0.032) and MACE (24.2% vs. 13.8%, log rank P = 0.005) were higher in the ostial group than the nonostial group with trends to increased incidence of myocardial infarction (6.6% vs. 4.7%, P = NS), and target vessel revascularization (13.2% vs. 7.9%, P = NS).Conclusion:In contemporary, Australian interventional practice, PCI for ostial lesions is associated with a high incidence of adverse outcome at one year despite the introduction of DES. © 2008 Wiley-Liss, Inc.

M3 - Article

SN - 1522-1946

VL - 73

SP - 763

EP - 768

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

IS - 6

ER -

Outcomes after percutaneous coronary intervention of ostial lesions in the era of drug-eluting stents

Abstract

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