Clinical outcome of patients with implantation of second-generation drug-eluting stents in the right coronary ostium: Insights from 2-year follow-up of the TWENTE trial

Ming Kai Lam, Hanim Sen, Kenneth Tandjung, Marije M. Löwik, Mounir W.Z. Basalus, Janne C. Mewes, Martin G. Stoel, K. Gert van Houwelingen, Gerard C.M. Linssen, Maarten J. IJzerman, Carine J.M. Doggen, Clemens von Birgelen

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Abstract

Objectives: The aim of the present study was to assess the impact on clinical outcome of right coronary artery (RCA) ostial coverage with second-generation drug-eluting stents (DES).

Background: Treatment of the aorta-ostial (AO) region of the RCA with bare metal stents and first-generation DES has been associated with a higher risk of target-lesion revascularization (TLR).

Methods: Of the 1,391 patients of the prospective TWENTE trial, we identified 321 (23%) with single-vessel RCA treatment, who were categorized into stenting with AO stent coverage (AOC) versus stenting without AOC. The AO region was defined as 3 mm from the aortic orifice.ResultsThe 67 (20.9%) patients with AOC showed more severe lesion calcifications than the 254 patients without AOC (31.3% vs. 12.6%; P < 0.01). In the AOC group, there was a higher prevalence of hypercholesterolemia and family history of coronary disease (75.4% vs. 61.6%, and 68.7% vs. 53.5%, respectively; P = 0.03). During 2-year follow-up, patients in the AOC group had a higher incidence of TLR (7.5% vs. 1.6%; P = 0.02). Following adjustment for confounders, AOC independently predicted TLR with an adjusted hazard ratio of 4.1 (95% CI: 1.17–14.39; P = 0.03).

Conclusion: AO treatment of the RCA with second-generation DES is feasible, but our data suggest that stent coverage of the right AO segment remains a predictor of TLR.

Original languageEnglish
Pages (from-to)524-531
JournalCatheterization and cardiovascular interventions
Volume85
Issue number4
DOIs
Publication statusPublished - 8 May 2015

Keywords

  • METIS-307075
  • IR-93176
  • Right coronary artery
  • Aorta-ostial lesion
  • Revascularization
  • Ostium
  • Drug-eluting stent(s)

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