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. 2023 Nov;102(6):1048-1056.
doi: 10.1002/ccd.30903. Epub 2023 Nov 7.

Clinical and procedural outcomes of percutaneous coronary intervention for de novo lesions involving the ostial left circumflex coronary artery

Ottavia Cozzi  1   2 , Matteo Maurina  1   2 , Michele Cacia  1   3 , Valentina Bernardini  4 , Aisha Gohar  1   5 , Davide Cao  1   4 , Antonio Mangieri  1   2 , Francesco Condello  1   2 , Pier Pasquale Leone  1   2 , Alessandro Sticchi  1   2 , Marco L Rossi  6 , Gabriele Gasparini  1   2 , Giulio G Stefanini  1   2 , Gianluigi Condorelli  1   2 , Bernhard Reimers  1   2 , Antonio Colombo  1   6 , Damiano Regazzoli  1   2
Affiliations

Clinical and procedural outcomes of percutaneous coronary intervention for de novo lesions involving the ostial left circumflex coronary artery

Ottavia Cozzi et al. Catheter Cardiovasc Interv. 2023 Nov.

Abstract

Background: Percutaneous treatment for ostial left circumflex artery (LCx) lesions is known to be associated with suboptimal results.

Aims: The present study aims to assess the procedural and long-term clinical outcomes of percutaneous coronary intervention (PCI) for de novo ostial LCx lesions overall and according to the coronary revascularization strategy.

Methods: Consecutive patients undergoing PCI with second generation drug eluting stents or drug coated balloons for de novo ostial LCx lesions in three high-volume Italian centers between 2012 and 2021 were retrospectively evaluated. The primary endpoint was target-vessel revascularization (TVR) at 2 years. Secondary endpoints included major adverse cardiovascular and cerebrovascular events (MACCE), target lesion revascularization, myocardial infarction, stroke, all-cause death, and repeat revascularization.

Results: A total of 366 patients were included in the analysis with a median follow-up of 901 (IQR: 450-1728) days. 79.5% of the patients were male, 33.6% were diabetic, 49.7% had a previous PCI, and 23.1% a prior surgical revascularization. Very ostial LCx stenting was performed in 34.1%, crossover from left main to LCx in 17.3%, and a two-stent strategy in 48.6% of cases, respectively. In the overall population, the incidence of TVR at 2 years was 19.0% while MACCE rate was 25.7%. No major differences in clinical outcomes were found according to the stenting strategy. Use of intracoronary imaging was associated with fewer MACCE (HR: 0.47, 95% CI: 0.25-1.13, p = 0.01), while the diameter of the stent implanted in the ostial LCx was associated with less TVR (HR: 0.43, 95% CI: 0.25-0.75, p = 0.002).

Conclusions: Percutaneous revascularization of the ostial LCx is associated with a high rate of TVR, regardless of the stenting strategy. Intracoronary imaging and proper stent sizing may reduce the failure rates.

Keywords: BIFL: bifurcation lesions; CAD: coronary artery disease; IVUS: imaging, intravascular ultrasound.

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References

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