Levi Yaniv, Kobo Ofer, Halabi Majdi, Al Haddad Imad, Chevalier Bernard, Polad Jawed, Laanmets Peep, Witkowski Adam, Monsegu Jacques, Iniguez Andres Romo, Mamas Mamas A, Roguin Ariel
Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel.
Department of Cardiology, Ziv Hospital, Safed, Israel.
J Soc Cardiovasc Angiogr Interv. 2023 Feb 25;2(3):100604. doi: 10.1016/j.jscai.2023.100604. eCollection 2023 May-Jun.
Treatment of right coronary artery (RCA) aorto-ostial (AO) lesions with bare-metal stents and first-generation drug-eluting stents (DES) was associated with worse outcomes. This study aimed to assess the effect of RCA-AO stenting with current-generation DES on the clinical outcome.
The large all-comer, multicontinental e-ULTIMASTER registry included 37,198 patients of whom 4775 underwent ostial and proximal RCA percutaneous coronary intervention (PCI) using the Ultimaster stent (Terumo). The primary clinical end point was 1-year target lesion failure (TLF), a composite of cardiac death; target vessel-related myocardial infarction; or clinically indicated target lesion revascularization.
We compared 591 (12.4%) patients who underwent RCA-AO PCI with 4184 (87.6%) patients who underwent proximal RCA PCI. The RCA-AO group included more men and recorded significantly more comorbidities and more complex coronary anatomy. After propensity matching, the primary end point TLF occurred in 4.49% of the RCA-AO group compared with 3.00% of the proximal RCA group ( = .06). Target vessel revascularization (3.29% vs 1.90%; = .03) and stent thrombosis (1.23% vs 0.42%, = .01) were significantly higher among patients with RCA-AO lesions than those among patients with proximal RCA lesions. All-cause mortality was similar between the groups (2.97% vs 2.26%; = .30).
The treatment of RCA-AO with DES is feasible, with similar rates of TLF but with an increased risk of target vessel revascularization and stent thrombosis.
使用裸金属支架和第一代药物洗脱支架（DES）治疗右冠状动脉（RCA）主动脉开口（AO）病变与较差的预后相关。本研究旨在评估使用当代DES进行RCA-AO支架置入术对临床结局的影响。
大型多中心、面向所有患者的e-ULTIMASTER注册研究纳入了37198例患者，其中4775例使用Ultimaster支架（泰尔茂）对RCA开口和近端进行经皮冠状动脉介入治疗（PCI）。主要临床终点为1年靶病变失败（TLF），这是一个综合指标，包括心源性死亡、靶血管相关心肌梗死或临床指征的靶病变血运重建。
我们将591例（12.4%）接受RCA-AO PCI的患者与4184例（87.6%）接受近端RCA PCI的患者进行了比较。RCA-AO组男性更多，合并症和冠状动脉解剖结构更复杂的情况显著更多。倾向评分匹配后，RCA-AO组的主要终点TLF发生率为4.49%，而近端RCA组为3.00%（P = 0.06）。RCA-AO病变患者的靶血管血运重建（3.29%对1.90%；P = 0.03）和支架血栓形成（1.23%对0.42%，P = 0.01）显著高于近端RCA病变患者。两组间全因死亡率相似（2.97%对2.26%；P = 0.30）。
使用DES治疗RCA-AO是可行的，TLF发生率相似，但靶血管血运重建和支架血栓形成风险增加。
