In:
Heart, BMJ, Vol. 109, No. 17 ( 2023-09), p. 1302-1309
Abstract:
Percutaneous coronary intervention (PCI) of the ostium of the left circumflex artery (LCx) is technically challenging. The aim of this study was to compare long-term clinical outcomes of ostial PCI located in the LCx versus the left anterior descending artery (LAD) in a propensity-matched population. Methods Consecutive patients with a symptomatic isolated ‘de novo’ ostial lesion of the LCx or LAD treated with PCI were included. Patients with a stenosis of 〉 40% in the left main (LM) were excluded. A propensity score matching was performed to compare both groups. The primary endpoint was target lesion revascularisation (TLR); other endpoints included target lesion failure and an analysis of the bifurcation angles. Results From 2004 to 2018, 287 consecutive patients with LAD (n=240) or LCx (n=47) ostial lesions treated with PCI were analysed. After the adjustment, 47 matched pairs were obtained. The mean age was 72±12 years and 82% were male. The LM–LAD angle was significantly wider than the LM–LCx angle (128°±23° vs 108°±24°, p=0.002). At a median follow-up of 5.5 (IQR 1.5–9.3) years, the rate of TLR was significantly higher in the LCx group (15% vs 2%); with an HR of 7.5, 95% CI 2.1 to 26.4, p 〈 0.001. Interestingly, in the LCx group, TLR–LM occurred in 43% of the TLR cases; meanwhile, no TLR–LM involvement was found in the LAD group. Conclusions Isolated ostial LCx PCI was associated with an increase in the rate of TLR compared with ostial LAD PCI at long-term follow-up. Larger studies evaluating the optimal percutaneous approach at this location are needed.
Type of Medium:
Online Resource
ISSN:
1355-6037
,
1468-201X
DOI:
10.1136/heartjnl-2022-322204
Language:
English
Publisher:
BMJ
Publication Date:
2023
detail.hit.zdb_id:
2378689-9
detail.hit.zdb_id:
1475501-4
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