Prevalence and outcomes of aorto-ostial percutaneous coronary intervention in a large contemporary cohort.

Abstract

Background: Aorto-ostial lesions are clinically significant, supplying large areas of myocardium and subject to more complex percutaneous coronary intervention (PCI) techniques. They have been associated with suboptimal clinical outcomes. Methods: Data were analysed from the multicentre Melbourne Intervention Group Registry from 2005–2020. Patients that underwent PCI for ostial left main coronary artery (LMCA) or right coronary artery (RCA) lesions were compared to patients undergoing PCI for proximal non ostial LMCA or RCA lesions. Results: 4,683 patients were included in the study population, of which 538 (11.5%) underwent PCI for aorto-ostial coronary disease and 4,145 (88.5%) underwent PCI for proximal but non-ostial LMCA or RCA coronary disease. 307 (6.6%) patients had a LMCA lesion and 4,376 (93.4%) had an RCA lesion. Patients in the ostial group were older (mean age 70.1 vs 65.0, p<0.001) and more often female (37.7% vs 25.5%, p<0.001). Aorto-ostial PCI was more frequently undertaken in non-acute coronary syndrome (42.8% vs 28.7%, p<0.001), with increased use of intravascular imaging (5.9% vs 1.2%, p<0.001). Death due to cardiovascular cause was similar (ostial 4.1% vs non ostial 2.8%, p=0.11), as were major adverse cardiac events (MACE; all-cause mortality, myocardial infarction, target vessel revascularisation) (7.5% vs 6.4%, p=0.35). Conclusions: Aorto-ostial PCI was not associated with significant difference in cardiovascular mortality or MACE at 30-days when compared to patients undergoing proximal lesion PCI. Intravascular imaging rates were low in both groups but was more utilised in the aorto-ostial group.