Ostial vs Left Main Crossover Stenting in Isolated Ostial Left Anterior Descending Stenosis: A Single-Center Retrospective Cohort Study

Abstract

Background

Limited data exist on the optimal stenting strategy for isolated ostial left anterior descending coronary artery (LAD) lesions. The aim of this study was to compare the outcomes in patients who had a significant isolated ostial LAD stenosis treated with either left main crossover stenting (LMCS) or focal ostial LAD stenting (FO-LAD).

Methods

The primary end point of the study was target lesion failure (TLF), a composite of target lesion revascularization, target vessel myocardial infarction, and cardiac death at 2 years. Secondary end points included the individual components of the primary outcome. Additional secondary outcomes included major adverse cardiovascular events, which are a composite of all-cause mortality, myocardial infarction, cerebrovascular accident, and any unplanned revascularization.

Results

A total of 522 patients were included in this study, of whom 382 underwent FO-LAD stenting and 140 underwent LMCS. The primary outcome occurred in 32 patients (22.9%) in the LMCS and in 44 patients (11.5%) in the FO-LAD group at a median follow-up of 730 days (IQR, 451-730). LMCS was associated with a higher risk of TLF compared with FO-LAD stenting (adjusted HR, 1.86; 95% CI, 1.16-2.98; P = .01).

With regard to secondary outcomes, LMCS was associated with more major adverse cardiovascular events (31.4% vs 15.5%; adjusted HR, 2.11 [1.41-3.17]; P < .001) and cardiac death (17.1% vs 7.9%; adjusted HR, 2.05 [1.19-3.55]; P = .01]. No significant differences were observed for target lesion revascularization and target vessel myocardial infarction.

Conclusions

Left main crossover stenting was associated with a higher rate of TLF at a median follow-up of 2 years when compared with FO-LAD stenting in the treatment of patients with significant isolated ostial LAD disease.