Long-term outcomes following ostial left anterior descending artery intervention with or without crossover to left-main

Osama Elkhateeb, Sunil Thambi, Hussein Beydoun, Helen Bishop, Ata Quraishi, Bakhtiar Kidwai, Lawrence Title, Osama Elkhateeb, Sunil Thambi, Hussein Beydoun, Helen Bishop, Ata Quraishi, Bakhtiar Kidwai, Lawrence Title

Abstract

Background: Ostial left anterior descending (LAD) artery lesions are a critical area for coronary stenting, given that the location subtends a large area of the myocardium and can also be more technically challenging. It remains controversial whether crossover stenting of ostial LAD back into the left-main (LM) is advantageous over stenting the ostium alone.

Methods: To evaluate the long-term clinical outcomes of stenting ostial LAD lesions, we retrospectively reviewed all ostial LAD lesions cases at QEII Health Science Centre between 2008 and 2018. Specifically, we compared the outcomes in those patients that had left main stent crossover vs. ostial stenting (OS) alone.

Results: The total number of patients included in the study was 175, with 25 patients (14%) having a crossover to the LM and 150 (86%) having OS. There were more patients with previous CABG (24%) in the crossover group compared to the OS group (9.2%) (P = 0.042). The one-year MACE was not significantly different between CO vs. OS (13.3% (10.5-16.1) vs. 12% (5.5-18.5)). The five-year MACE was numerically higher, although statistically not significant, in CO vs. OS (19.3 (15.9-22.7) vs. 25.9 (16.6-35.2)).

Conclusion: This study shows that percutaneous intervention provides reasonable long-term outcomes and low rates of repeat revascularization for isolated ostial LAD lesions, with no noticeable difference in outcomes with crossover stenting into the LM vs. OS alone. A larger, prospective study may be required to determine the optimal strategy for treating ostial LAD lesions.

Keywords: LM - left main coronary disease; PCI - percutaneous coronary intervention (PCI); stenting technique.

Conflict of interest statement

None.

AJCD Copyright © 2022.

Figures

Figure 1
Figure 1
Study flow chart for selected patients. LAD = Left anterior descending artery.
Figure 2
Figure 2
Kaplan-Meier curve for Mortality and MACE, including TLR, TVR and all-cause mortality. MACE = major adverse cardiac events, LM = Left-Main, TLR = target lesion revascularization, TVR = target vessel revascularization.

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