Key result
Sirolimus-eluting stents cut TLR ~23 percentage points vs BMS in ostial RCA lesions.
Why the study?
Ostial lesions of the right coronary artery have been a limitation of PCI with previous devices, and the angiographic and clinical outcomes after sirolimus-eluting stent deployment to right coronary artery ostial lesions had not been fully estimated.
Does sirolimus-eluting stent implantation reduce binary restenosis and target lesion revascularization in de novo ostial lesions of the right coronary artery compared with bare metal stents in ostial lesions and sirolimus-eluting stents in proximal right coronary artery lesions?
Cohort (n=135)
No
Does sirolimus-eluting stent implantation reduce binary restenosis and target lesion revascularization in de novo ostial lesions of the right coronary artery compared with bare metal stents in ostial lesions and sirolimus-eluting stents in proximal right coronary artery lesions?
Answers are grounded in this paper and cite their sources.
Although sirolimus-eluting stents significantly reduce binary restenosis and target lesion revascularization in right coronary artery ostial lesions compared with bare metal stents, ostial lesions remain a limitation of SES therapy with markedly higher restenosis and revascularization rates than proximal RCA lesions.
BACKGROUND: Although ostial lesion (defined as being within 3 mm of the ostia) of the right coronary artery (RCAos) has been a limitation of percutaneous coronary intervention after using previous various devices, the angiographic and clinical outcomes after the deployment of a sirolimus-eluting stent (SES) to RCAos have not been fully estimated. Therefore, the incidences of binary restenosis (BR; % diameter stenosis at chronic phase <or=50) and target lesion revascularization (TLR) after SES to RCAos were retrospectively compared with those after SES to RCA proximal (RCApro) and those after bare metal stents (BMS) to RCAos. METHODS AND RESULTS: The ratios of BR (18.9%) and TLR (13.5%) after SES to RCAos (n=37, mean follow-up interval of each group was 249 days) were significantly decreased compared with those of BMS to RCAos (41.7%, 36.1%, p<0.01, respectively) (n=36, 194 days), but were significantly increased compared with those of SES to RCApro (4.84%, 1.61%, p<0.01, respectively) (n=62, 240 days). There were no incidences of death, myocardial infarction, and definite stent thrombosis during the observational intervals in the entire cohort of 125 patients. CONCLUSIONS: RCAos has to be taken into consideration as one of the limitations of SES because of the marked increase in the incident ratios of BR and TLR compared with those of RCApro, although SES demonstrated a likewise benefit compared with BMS.
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Sakamoto et al. (2008) conducted a cohort in De novo ostial or proximal lesions of the right coronary artery (n=135). Sirolimus-eluting stent (SES) implantation to right coronary artery ostial lesion (RCAos) vs. Bare metal stent (BMS) implantation to RCAos (n=36) and SES implantation to proximal RCA (RCApro, n=62) was evaluated on Target lesion revascularization (TLR) and major adverse cardiac events (MACE) (p=<0.01). Sirolimus-eluting stent implantation in right coronary artery ostial lesions reduced target lesion revascularization vs bare metal stents (13.5% vs 36.1%, p<0.01) but increased it vs proximal lesions (1.61%, p<0.01).
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