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. 2024 Feb 5;20(3):e207-e215.
doi: 10.4244/EIJ-D-23-00406.

Ostial right coronary artery lesion morphology and outcomes after treatment with drug-eluting stents

Kei Yamamoto  1   2 , Takao Sato  1   2 , Hanan Salem  1   2   3 , Yu-Wei Chen  1   2 , Mitsuaki Matsumura  2 , Nikolas Bletnitsky  1 , Khady N Fall  1 , Megha Prasad  1 , Vivian G Ng  1 , Sanjum S Sethi  1 , Tamim M Nazif  1   2 , Sahil A Parikh  1   2 , Torsten P Vahl  1   2 , Ziad A Ali  2   4 , Dimitri Karmpaliotis  2   5 , LeRoy E Rabbani  1   2 , Michael B Collins  1 , Martin B Leon  1   2 , Margaret B McEntegart  1   2 , Jeffery W Moses  1   2   4 , Ajay J Kirtane  1   2 , Gary S Mintz  2 , Akiko Maehara  1   2
Affiliations

Ostial right coronary artery lesion morphology and outcomes after treatment with drug-eluting stents

Kei Yamamoto et al. EuroIntervention. .

Abstract

Background: Outcomes after percutaneous coronary intervention (PCI) for de novo ostial right coronary artery (RCA) lesions are poor.

Aims: We used intravascular ultrasound (IVUS) to clarify the morphological patterns of de novo ostial RCA lesions and their associated clinical outcome.

Methods: Among 5,102 RCA IVUS studies, 170 de novo ostial RCA stenoses (within 3 mm from the aorto-ostium) were identified. These were classified as 1) isolated ostial lesions (no disease extending beyond 10 mm from the ostium and without a calcified nodule [CN]); 2) ostial CN, typically with diffuse disease (disease extending beyond 10 mm); and 3) ostial lesions with diffuse disease but without a CN. The primary outcome was target lesion failure (TLF: cardiac death, target vessel myocardial infarction, definite stent thrombosis, and ischaemia-driven target lesion revascularisation).

Results: The prevalence of an isolated ostial lesion was 11.8% (n=20), 47.6% (n=81) were ostial CN, and 40.6% (n=69) were ostial lesions with diffuse disease. Compared to ostial lesions with diffuse disease, isolated lesions were more common in women (75.0% vs 42.0%; p=0.01), and CN were associated with older age (median [first, third quartile] 76 [70, 83] vs 69 [63, 81] years old; p=0.002). The Kaplan-Meier rate of TLF at 2 years was significantly higher in patients with CN (21.6%) compared to diffuse lesions (8.2%) (p=0.04), and patients with isolated lesions had no events. A multivariable Cox proportional hazard model revealed that CN were significantly associated with TLF (hazard ratio 6.63, 95% confidence interval: 1.28-34.3; p=0.02).

Conclusions: Ostial RCA lesions have specific morphologies - detectable by IVUS - that may be associated with long-term clinical outcomes.

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Conflict of interest statement

M. Matsumura is a consultant for Terumo Corporation and Boston Scientific. K.N. Fall is a consultant for Infraredx and Boston Scientific. M. Prasad is a consultant for and is on the speakers bureau of Conavi Medical, Neovasc, Abbott, Cardinol, Chiesi, and Boehringer Ingelheim. V.G. Ng receives speaker honoraria from Edwards Lifesciences and Medtronic. T.M. Nazif is a consultant for and receives speaker honoraria from Medtronic and Boston Scientific. S.A. Parikh has done research for Abbott, Boston Scientific, Medtronic, Philips, Cordis, and Jannsen; is a consultant for Inari, Penumbra, Terumo, and Canon; and holds equity in Efemoral Medical, Advanced NanoTherapies, and Encompass Vascular. D. Karmpaliotis received speaker honoraria from Boston Scientific and Abbott; and holds equity in Saranas, SoundBite Medical Solutions, and Traverse Vascular. M.B. Leon received institutional clinical research grants from Abbott, Boston Scientific, and Medtronic. M. McEntegart received speaker honoraria from Boston Scientific, Abbott, Shockwave Medical, Teleflex, and Biosensors. J.W. Moses has equity in Orchestra BioMed and Xenter. A.J. Kirtane received institutional funding from Medtronic, Boston Scientific, Abbott, Amgen, CathWorks, CSI, Philips, ReCor Medical, Neurotronics, Biotronik, Chiesi, Bolt Medical, Magenta Medical, Canon, SoniVie, and Shockwave Medical (institutional funding includes fees paid to Columbia University and/or Cardiovascular Research Foundation for consulting and/or speaking engagements in which A.J. Kirtane controlled the content); is a consultant for IMDS; received travel expenses/meals from Amgen, Medtronic, Biotronik, Boston Scientific, Abbott, CathWorks, Edwards Lifesciences, CSI, Novartis, Philips, Abiomed, ReCor Medical, Chiesi, Zoll, Shockwave Medical, and Regeneron. G.S. Mintz received speaker honoraria from Boston Scientific, Philips, SpectraWAVE, and Gentuity. A. Maehara is a consultant for Boston Scientific, Shockwave Medical, and SpectraWAVE. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Representative cases of each group.
In each example, the preprocedural coronary angiogram is shown (A) with the angiograms corresponding to the IVUS images (B,C,D,E). The top row shows an isolated lesion: the lesion was limited to the ostium (C,D) and showed negative remodelling (remodelling index 0.61). The middle row shows a calcified nodule: a calcified nodule (CN; blue asterisk) was seen at the ostium of the right coronary artery (B,C,D). The bottom row shows an ostial lesion with diffuse disease (diffuse lesions): non-CN plaque was seen at the ostium (D,E) as well as in the mid-segment (C). IVUS: intravascular ultrasound
Figure 2
Figure 2. Kaplan-Meier curve for target lesion failure among isolated, CN, and diffuse lesions.
CI: confidence interval; CN: calcified nodule; HR: hazard ratio
Central Illustration
Central Illustration. Results from 170 ostial RCA de novo lesions.
CN: calcified nodule; RCA: right coronary artery
See this image and copyright information in PMC

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