Skip to main content
SpringerLink
Log in

Sirolimus-eluting stent implantation for ostial right coronary artery lesions: five-year outcomes from the j-Cypher registry

  • Original Article
  • Published:
Cardiovascular Intervention and Therapeutics Aims and scope Submit manuscript

Abstract

Ostial right coronary artery (RCA) lesions are associated with a high restenosis rate after bare-metal stent implantation. However, long-term outcomes after drug-eluting stent (DES) implantation for ostial RCA lesions have not been adequately evaluated. Among 12824 patients enrolled in the j-Cypher registry, 5-year outcomes were compared between 397 patients with ostial RCA lesions, and 3716 patients with non-ostial RCA lesions treated with sirolimus-eluting stents (SES). Through 5-year follow-up, patients with ostial RCA lesions had a significantly higher cumulative incidence of target lesion revascularization (TLR) (28.2 versus 13.7 %, P < 0.0001) than those with non-ostial RCA lesions. After adjusting for confounders, excess TLR risk of the ostial group relative to the non-ostial group was significant for both early TLR within 1-year and late TLR beyond 1-year (HR 2.14 [95 % CI 1.59–2.84], P < 0.0001, and HR 1.58 [95 % CI 1.06–2.26], P = 0.02, respectively). Although the cumulative incidence of death was also significantly higher in the ostial group than in the non-ostial group (25.7 versus 14.4 %, P < 0.0001), the excess risk of the ostial group relative to the non-ostial group was no longer significant after adjusting for confounders (HR 1.25 [95 % CI 0.99–1.57], P = 0.07). SES implantation for ostial RCA lesions was associated with higher risk for TLR as compared with that for non-ostial RCA lesions. Restenosis, both early and late, remains an issue in coronary DES implantation for ostial RCA lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Topol EJ, Ellis SG, Fishman J, Leimgruber P, Myler RK, Stertzer SH, et al. Multicenter study of percutaneous transluminal angioplasty for right coronary artery ostial stenosis. J Am Coll Cardiol. 1987;9:1214–8.

    Article  CAS  PubMed  Google Scholar 

  2. Hoffmann R, Mintz GS, Mehran R, Pichard AD, Kent KM, Satler LF, et al. Intravascular ultrasound predictors of angiographic restenosis in lesions treated with Palmaz-Schatz stents. J Am Coll Cardiol. 1998;31:43–9.

    Article  CAS  PubMed  Google Scholar 

  3. Popma JJ, Brogan WC 3rd, Pichard AD, Satler LF, Kent KM, Mintz GS, et al. Rotational coronary atherectomy of ostial stenoses. Am J Cardiol. 1993;71:436–8.

    Article  CAS  PubMed  Google Scholar 

  4. Eigler NL, Weinstock B, Douglas JS Jr, Goldenberg T, Hartzler G, Holmes D, et al. Excimer laser coronary angioplasty of aorto-ostial stenoses. Results of the excimer laser coronary angioplasty (ELCA) registry in the first 200 patients. Circulation. 1993;88:2049–57.

    Article  CAS  PubMed  Google Scholar 

  5. Zampieri P, Colombo A, Almagor Y, Maiello L, Finci L. Results of coronary stenting of ostial lesions. Am J Cardiol. 1994;73:901–3.

    Article  CAS  PubMed  Google Scholar 

  6. Kurbaan AS, Kelly PA, Sigwart U. Cutting balloon angioplasty and stenting for aorto-ostial lesions. Heart. 1997;77:350–2.

    CAS  PubMed Central  PubMed  Google Scholar 

  7. Jain SP, Liu MW, Dean LS, Babu R, Goods CM, Yadav JS, et al. Comparison of balloon angioplasty versus debulking devices versus stenting in right coronary ostial lesions. Am J Cardiol. 1997;79:1334–8.

    Article  CAS  PubMed  Google Scholar 

  8. Kotani J, Ikari Y, Kyo E, Nakamura M, Yokoi H, Furuno K, et al. Five-year outcomes of Cypher™ coronary stent: report from J-PMS Study. Cardiovasc Interv Ther. 2012;27(2):63–71 Epub 2012 Jan 17.

    Article  PubMed  Google Scholar 

  9. Kyono H, Kozuma K, Shiratori Y, Maeno Y, Iino R, Takada K, et al. Angiographic and clinical outcomes of 100 consecutive severe calcified lesions requiring rotational atherectomy prior to sirolimus-eluting stent implantation in hemodialysis and non-hemodialysis patients. Cardiovasc Interv Ther. 2011;26(2):98–103.

    Article  PubMed  Google Scholar 

  10. Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med. 2002;346:1773–80.

    Article  CAS  PubMed  Google Scholar 

  11. Kimura T, Morimoto T, Nakagawa Y, Tamura T, Kadota K, Yasumoto H, et al. Antiplatelet therapy and stent thrombosis after sirolimus-eluting stent implantation. Circulation. 2009;119:987–95.

    Article  CAS  PubMed  Google Scholar 

  12. Serruys PW, Unger F, Sousa JE, Jatene A, Bonnier HJ, Schonberger JP, et al. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med. 2001;344:1117–24.

    Article  CAS  PubMed  Google Scholar 

  13. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007;115:2344–51.

    Article  PubMed  Google Scholar 

  14. Kimura T, Morimoto T, Nakagawa Y, Kawai K, Miyazaki S, Muramatsu T, et al. Very late stent thrombosis and late target lesion revascularization after sirolimus-eluting stent implantation: five-year outcome of the j-cypher registry. Circulation. 2012;125:584–91.

    Article  CAS  PubMed  Google Scholar 

  15. Iakovou I, Ge L, Michev I, Sangiorgi GM, Montorfano M, Airoldi F, et al. Clinical and angiographic outcome after sirolimus-eluting stent implantation in aorto-ostial lesions. J Am Coll Cardiol. 2004;44:967–71.

    Article  CAS  PubMed  Google Scholar 

  16. Park DW, Hong MK, Suh IW, Hwang ES, Lee SW, Jeong YH, et al. Results and predictors of angiographic restenosis and long-term adverse cardiac events after drug-eluting stent implantation for aorto-ostial coronary artery disease. Am J Cardiol. 2007;99:760–5.

    Article  CAS  PubMed  Google Scholar 

  17. Al-Lamee R, Ielasi A, Latib A, Godino C, Mussardo M, Arioli F, et al. Comparison of long-term clinical and angiographic outcomes following implantation of bare metal stents and drug-eluting stents in aorto-ostial lesions. Am J Cardiol. 2011;108:1055–60.

    Article  CAS  PubMed  Google Scholar 

  18. Luz A, Hughes C, Magalhaes R, Bisceglia T, Descoutures F, Tamamm K, et al. Stent implantation in aorto-ostial lesions: long-term follow-up and predictors of outcome. EuroIntervention. 2012;7:1069–76.

    Article  PubMed  Google Scholar 

  19. Vasaiwala S, Vlachos H, Selzer F, Marroquin O, Mulukutla S, Abbott JD, et al. Comparison of bare-metal stents and drug-eluting stents in coronary ostial lesions (from the national heart, lung, and blood institute dynamic registry). Am J Cardiol. 2012;110:1113–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Chieffo A, Park SJ, Valgimigli M, Kim YH, Daemen J, Sheiban I, et al. Favorable long-term outcome after drug-eluting stent implantation in nonbifurcation lesions that involve unprotected left main coronary artery: a multicenter registry. Circulation. 2007;116:158–62.

    Article  CAS  PubMed  Google Scholar 

  21. Palmerini T, Sangiorgi D, Marzocchi A, Tamburino C, Sheiban I, Margheri M, et al. Ostial and midshaft lesions vs. Bifurcation lesions in 1111 patients with unprotected left main coronary artery stenosis treated with drug-eluting stents: results of the survey from the Italian Society of Invasive Cardiology. Eur Heart J. 2009;30:2087–94.

    Article  PubMed  Google Scholar 

  22. Toyofuku M, Kimura T, Morimoto T, Hayashi Y, Ueda H, Kawai K, et al. Three-year outcomes after sirolimus-eluting stent implantation for unprotected left main coronary artery disease: insights from the j-Cypher registry. Circulation. 2009;120:1866–74.

    Article  PubMed  Google Scholar 

  23. Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. Guidelines on myocardial revascularization. Eur Heart J. 2010;31:2501–55.

    Article  PubMed  Google Scholar 

  24. Sakamoto H, Ishikawa T, Mutoh M, Imai K, Mochizuki S. Angiographic and clinical outcomes after sirolimus-eluting stent implantation to de novo ostial lesion of the right coronary artery: a retrospective study. Circ J. 2008;72:880–5.

    Article  PubMed  Google Scholar 

  25. Stewart JT, Ward DE, Davies MJ, Pepper JR. Isolated coronary ostial stenosis: observations on the pathology. Eur Heart J. 1987;8:917–20.

    CAS  PubMed  Google Scholar 

  26. Popma JJ, Dick RJ, Haudenschild CC, Topol EJ, Ellis SG. Atherectomy of right coronary ostial stenoses: initial and long-term results, technical features and histologic findings. Am J Cardiol. 1991;67:431–3.

    Article  CAS  PubMed  Google Scholar 

  27. Boucek RJ, Takeshita R, Brady AH. Microanatomy and intramural physical forces within the coronary arteries (man). Anat Rec. 1965;153:233–41.

    Article  CAS  PubMed  Google Scholar 

  28. Tsunoda T, Nakamura M, Wada M, Ito N, Kitagawa Y, Shiba M, et al. Chronic stent recoil plays an important role in restenosis of the right coronary ostium. Coron Artery Dis. 2004;15:39–44.

    Article  PubMed  Google Scholar 

  29. Kim SW, Mintz GS, Ohlmann P, Hassani SE, Michalek A, Escolar E, et al. Comparative intravascular ultrasound analysis of ostial disease in the left main versus the right coronary artery. J Invasive Cardiol. 2007;19:377–80.

    PubMed  Google Scholar 

Download references

Acknowledgments

We thank the members of the cardiac catheterization laboratories of the participating centers and the clinical research coordinators.

Conflict of interest

We have no conflicts to disclose.

Author information

Authors and Affiliations

  1. Japanese Red Cross Society Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan

    Euihong Ko, Mamoru Toyofuku, Yukiko Matsumura, Maki Oi, Yasuyo Motohashi, Kousuke Takahashi, Yuichi Kawase, Mariko Tanaka, Masahiko Kitada, Yosuke Yuzuki & Takashi Tamura

  2. Kyoto University, Kyoto, Japan

    Masahiro Natsuaki & Takeshi Kimura

  3. Center for General Internal Medicine and Emergency Care, Kinki University School of Medicine, Osaka, Japan

    Takeshi Morimoto

  4. Kokura Memorial Hospital, Fukuoka, Japan

    Katsumi Inoue

  5. Kurashiki Central Hospital, Kurashiki, Japan

    Kazuaki Mitsudo

Authors
  1. Euihong Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masahiro Natsuaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mamoru Toyofuku
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takeshi Morimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yukiko Matsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maki Oi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasuyo Motohashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kousuke Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuichi Kawase
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mariko Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masahiko Kitada
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yosuke Yuzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Takashi Tamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Katsumi Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Kazuaki Mitsudo
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Takeshi Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mamoru Toyofuku.

Additional information

E. Ko and M. Natsuaki contributed equally to this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 29 kb)

Supplementary material 2 (DOC 250 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ko, E., Natsuaki, M., Toyofuku, M. et al. Sirolimus-eluting stent implantation for ostial right coronary artery lesions: five-year outcomes from the j-Cypher registry. Cardiovasc Interv and Ther 29, 200–208 (2014). https://doi.org/10.1007/s12928-013-0236-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12928-013-0236-2

Keywords

Search

Navigation