PCI for Ostial Stenosis of Left Circumflex or Left Anterior Descending Artery

Abstract

Background

To date, the clinical outcome of ostial stent implantation (OSI) in patients with ostial left circumflex artery (LCX) or left anterior descending artery (LAD) lesions has not been well established. This study sought to assess the cardiovascular outcomes of the ostial stent implantation (OSI) for the ostial LAD or LCX lesions under long-term follow-up.

Methods

This large-scale, multicenter (n = 13) observational, retrospective study included 839 patients (men: 619 [73.8%], mean age: 61.36 ± 11.93 years) who underwent PCI with OSI for ostial LAD or LCX lesions between 2014 and 2025. The primary outcome was major adverse cardiac events (MACE), including cardiac death, target lesion revascularisation, and target vessel myocardial infarction.

Results

The study cohort was divided into two groups: ostial LAD (n = 590) and ostial LCX (n = 249) revascularized with OSI. SYNTAX scores and the utilization of intravascular imaging rates were similar in both groups. Total stent length (22.79 ± 7.37 vs. 24.60 ± 7.57 mm, p = 0.001) was notably lower in the LCX group; however, the rate of bailout 2-stent technique (6.4 vs. 2.7%, p = 0.010) was significantly higher in the LCX group than in the LAD group. The risk-adjusted long-term MACE (HR: 1.591, p = 0.010) significantly differed in individuals with left-sided ostial lesions to revascularize with OSI. Additionally, diabetes mellitus, chronic kidney disease, intravascular imaging, reduced left ventricle ejection fraction, high SYNTAX score, statin usage, and total stent length were found to be independent predictors of MACE.

Conclusions

This multicenter study demonstrates that the location of ostial stenosis in LCX was associated with a higher risk-adjusted MACE rate at long-term follow-up.