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Propensity-matched analysis of long-term clinical results after ostial circumflex revascularisation

BACKGROUND: Percutaneous coronary intervention (PCI) of the ostium of the left circumflex artery (LCx) is technically challenging. The aim of this study was to compare long-term clinical outcomes of ostial PCI located in the LCx versus the left anterior descending artery (LAD) in a propensity-matche...

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Autores principales: Espejo-Paeres, Carolina, Vedia, Oscar, Wang, Lin, Hennessey, Breda, Mejía-Rentería, Hernán, McInerney, Angela, Nombela-Franco, Luis, Nuñez-Gil, Ivan Javier, Macaya-Ten, Fernando, Salinas, Pablo, Tirado, Gabriela, Fernandez-Ortiz, Antonio Ignacio, Gonzalo, Nieves, Escaned, Javier, Jimenez-Quevedo, Pilar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423548/
https://www.ncbi.nlm.nih.gov/pubmed/37217296
http://dx.doi.org/10.1136/heartjnl-2022-322204
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author Espejo-Paeres, Carolina
Vedia, Oscar
Wang, Lin
Hennessey, Breda
Mejía-Rentería, Hernán
McInerney, Angela
Nombela-Franco, Luis
Nuñez-Gil, Ivan Javier
Macaya-Ten, Fernando
Salinas, Pablo
Tirado, Gabriela
Fernandez-Ortiz, Antonio Ignacio
Gonzalo, Nieves
Escaned, Javier
Jimenez-Quevedo, Pilar
author_facet Espejo-Paeres, Carolina
Vedia, Oscar
Wang, Lin
Hennessey, Breda
Mejía-Rentería, Hernán
McInerney, Angela
Nombela-Franco, Luis
Nuñez-Gil, Ivan Javier
Macaya-Ten, Fernando
Salinas, Pablo
Tirado, Gabriela
Fernandez-Ortiz, Antonio Ignacio
Gonzalo, Nieves
Escaned, Javier
Jimenez-Quevedo, Pilar
author_sort Espejo-Paeres, Carolina
collection PubMed
description BACKGROUND: Percutaneous coronary intervention (PCI) of the ostium of the left circumflex artery (LCx) is technically challenging. The aim of this study was to compare long-term clinical outcomes of ostial PCI located in the LCx versus the left anterior descending artery (LAD) in a propensity-matched population. METHODS: Consecutive patients with a symptomatic isolated ‘de novo’ ostial lesion of the LCx or LAD treated with PCI were included. Patients with a stenosis of >40% in the left main (LM) were excluded. A propensity score matching was performed to compare both groups. The primary endpoint was target lesion revascularisation (TLR); other endpoints included target lesion failure and an analysis of the bifurcation angles. RESULTS: From 2004 to 2018, 287 consecutive patients with LAD (n=240) or LCx (n=47) ostial lesions treated with PCI were analysed. After the adjustment, 47 matched pairs were obtained. The mean age was 72±12 years and 82% were male. The LM–LAD angle was significantly wider than the LM–LCx angle (128°±23° vs 108°±24°, p=0.002). At a median follow-up of 5.5 (IQR 1.5–9.3) years, the rate of TLR was significantly higher in the LCx group (15% vs 2%); with an HR of 7.5, 95% CI 2.1 to 26.4, p<0.001. Interestingly, in the LCx group, TLR–LM occurred in 43% of the TLR cases; meanwhile, no TLR–LM involvement was found in the LAD group. CONCLUSIONS: Isolated ostial LCx PCI was associated with an increase in the rate of TLR compared with ostial LAD PCI at long-term follow-up. Larger studies evaluating the optimal percutaneous approach at this location are needed.
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spelling pubmed-104235482023-08-14 Propensity-matched analysis of long-term clinical results after ostial circumflex revascularisation Espejo-Paeres, Carolina Vedia, Oscar Wang, Lin Hennessey, Breda Mejía-Rentería, Hernán McInerney, Angela Nombela-Franco, Luis Nuñez-Gil, Ivan Javier Macaya-Ten, Fernando Salinas, Pablo Tirado, Gabriela Fernandez-Ortiz, Antonio Ignacio Gonzalo, Nieves Escaned, Javier Jimenez-Quevedo, Pilar Heart Coronary Artery Disease BACKGROUND: Percutaneous coronary intervention (PCI) of the ostium of the left circumflex artery (LCx) is technically challenging. The aim of this study was to compare long-term clinical outcomes of ostial PCI located in the LCx versus the left anterior descending artery (LAD) in a propensity-matched population. METHODS: Consecutive patients with a symptomatic isolated ‘de novo’ ostial lesion of the LCx or LAD treated with PCI were included. Patients with a stenosis of >40% in the left main (LM) were excluded. A propensity score matching was performed to compare both groups. The primary endpoint was target lesion revascularisation (TLR); other endpoints included target lesion failure and an analysis of the bifurcation angles. RESULTS: From 2004 to 2018, 287 consecutive patients with LAD (n=240) or LCx (n=47) ostial lesions treated with PCI were analysed. After the adjustment, 47 matched pairs were obtained. The mean age was 72±12 years and 82% were male. The LM–LAD angle was significantly wider than the LM–LCx angle (128°±23° vs 108°±24°, p=0.002). At a median follow-up of 5.5 (IQR 1.5–9.3) years, the rate of TLR was significantly higher in the LCx group (15% vs 2%); with an HR of 7.5, 95% CI 2.1 to 26.4, p<0.001. Interestingly, in the LCx group, TLR–LM occurred in 43% of the TLR cases; meanwhile, no TLR–LM involvement was found in the LAD group. CONCLUSIONS: Isolated ostial LCx PCI was associated with an increase in the rate of TLR compared with ostial LAD PCI at long-term follow-up. Larger studies evaluating the optimal percutaneous approach at this location are needed. BMJ Publishing Group 2023-09 2023-05-22 /pmc/articles/PMC10423548/ /pubmed/37217296 http://dx.doi.org/10.1136/heartjnl-2022-322204 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Coronary Artery Disease
Espejo-Paeres, Carolina
Vedia, Oscar
Wang, Lin
Hennessey, Breda
Mejía-Rentería, Hernán
McInerney, Angela
Nombela-Franco, Luis
Nuñez-Gil, Ivan Javier
Macaya-Ten, Fernando
Salinas, Pablo
Tirado, Gabriela
Fernandez-Ortiz, Antonio Ignacio
Gonzalo, Nieves
Escaned, Javier
Jimenez-Quevedo, Pilar
Propensity-matched analysis of long-term clinical results after ostial circumflex revascularisation
title Propensity-matched analysis of long-term clinical results after ostial circumflex revascularisation
title_full Propensity-matched analysis of long-term clinical results after ostial circumflex revascularisation
title_fullStr Propensity-matched analysis of long-term clinical results after ostial circumflex revascularisation
title_full_unstemmed Propensity-matched analysis of long-term clinical results after ostial circumflex revascularisation
title_short Propensity-matched analysis of long-term clinical results after ostial circumflex revascularisation
title_sort propensity-matched analysis of long-term clinical results after ostial circumflex revascularisation
topic Coronary Artery Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423548/
https://www.ncbi.nlm.nih.gov/pubmed/37217296
http://dx.doi.org/10.1136/heartjnl-2022-322204
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