Comparison of early- and new-generation drug-eluting stent implantations for ostial right coronary artery lesions.

Abstract

Percutaneous coronary intervention (PCI) with early-generation drug-eluting stent (eDES) implantation for ostial right coronary artery (RCA) lesions is challenging because of the frequent need for repeat revascularization. We compared midterm clinical outcomes following eDES or new-generation DES (nDES) implantation for ostial RCA lesions. The study included 150 patients with ostial RCA lesions, 76 treated with eDES and 74 with nDES between January 2005 and September 2013. Study endpoints were major adverse cardiac events (MACEs), specifically all-cause death, target lesion revascularization (TLR), or myocardial infarction within 2years after PCI. Patient characteristics between the groups were similar. The MACE rate was significantly lower in patients treated with nDES compared with those treated with eDES, mainly driven by the lower rates of TLR in the nDES group. Cox regression analysis identified severe chronic kidney disease (CKD) and the use of nDES as the independent predictors of MACE. The implantation of nDES for ostial RCA lesions significantly reduced the MACE rate compared with early-generation DES, mainly driven by a reduction in the TLR rate. However, nDES implantations for ostial RCA lesions may still be challenging in patients with severe CKD.