Background: Drug-eluting stents (DES) are increasingly used in percutaneous coronary interventions (PCI) in various subsets of lesions and patients (pts). Ostial lesions continue to be a challenge for PCI. This study aimed to evaluate the efficacy and safety of DES for the treatment of native ostial lesions.
Methods: A total 61 pts with 63 ostial lesions (Ostial group) and 1405 pts with 1716 non-ostial lesions (Non-ostial group) underwent standard PCI with DES. Eighty percent of pts were treated with Sirolimus-eluting Stent (Cypher^TM) and 20% with Paclitaxel-eluting Stent (Taxus^TM) in both groups. The in-hospital, 30-day and 6-month clinical outcomes in both groups were compared.
Results: Baseline characteristics were similar between the two groups except for more history of hypertension, hyperlipidemia, and restenotic lesions in the Ostial group. The Ostial group pts also had higher incidence of cardiogenic shock on admission and chronic heart failure. The Ostial group was treated more with directional atherectomy and cutting balloon angioplasty during the PCI. Despite these worse clinical characteristics, the procedural success and the in-hospital complications were similar. At 30 days, the Ostial group had a trend toward more subacute stent thrombosis (2.1% vs. 0.3%, P=0.06). At 6 months, the Ostial group had higher incidence of death (9.3% vs. 2.9%, P=0.04) without increasing other adverse cardiac events.
Conclusion: Treatment of native ostial lesions in pts undergoing PCI with DES is safe and feasible with low procedural and in-hospital complications despite adverse baseline characteristics. Thirty-day and 6-month clinical follow-up showed sustained benefit of DES on the ostial lesions without increasing MI, TLR, TVR and MACE. Cautions should be emphasized to minimize subacute stent thrombosis.