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. 2023 Aug 11;109(17):1302-1309.
doi: 10.1136/heartjnl-2022-322204.

Propensity-matched analysis of long-term clinical results after ostial circumflex revascularisation

Carolina Espejo-Paeres  1 , Oscar Vedia  1 , Lin Wang  1 , Breda Hennessey  1 , Hernán Mejía-Rentería  1 , Angela McInerney  1 , Luis Nombela-Franco  1 , Ivan Javier Nuñez-Gil  1 , Fernando Macaya-Ten  1 , Pablo Salinas  1 , Gabriela Tirado  1 , Antonio Ignacio Fernandez-Ortiz  1 , Nieves Gonzalo  1 , Javier Escaned  1 , Pilar Jimenez-Quevedo  2
Affiliations

Propensity-matched analysis of long-term clinical results after ostial circumflex revascularisation

Carolina Espejo-Paeres et al. Heart. .

Abstract

Background: 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.

Keywords: acute coronary syndrome; aneurysm, dissecting; atherosclerosis; cardiac catheterization; percutaneous coronary intervention.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Main figure. (A) Example of LAD–LMA angle offline 3D reconstruction (Medis Suite V.3.2.61.0) and angle measurement (150°). (B) Example of LCx–LMA angle offline 3D reconstruction and angle measurement (90°). (C) Boxplot, comparison of angle measurements according to vessel (LAD or LCx). (D) Kaplan-Meier TLR-free survival estimates at 5-year follow-up (LAD vs LCx); log-rank test, p=0.009. *, QFR; #, vessel diameter in millimetre. 3D, three-dimensional; LAD, left anterior descending artery; LCx, left circumflex artery; LMA, left main artery; QFR, quantitative flow ratio; TLR, target lesion revascularisation.
Figure 2
Figure 2
Flowchart. Patients with isolated ostial stenosis located in LAD or LCx detected in coronary angiographies performed between 2004 and 2018. CABG, coronary artery bypass grafting; LAD, left anterior descending artery; LCx, left circumflex artery; PCI, percutaneous coronary intervention.
Figure 3
Figure 3
Different analyses for TLR rates according to subgroups. CKD, chronic kidney disease; IVUS, intravascular ultrasound; LAD, left anterior descending artery; LCx, left circumflex artery; PCI, percutaneous coronary intervention; TLR, target lesion revascularisation.
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