Evaluation of Long-Term Outcomes of Crossover or Focal Ostial Stenting of Left Anterior Descending Artery Ostial Stenosis

Abstract

Background: Optimal management of patients with ostial left anterior descending artery stenosis remains an unresolved issue. Methods: Patients with ostial left anterior descending stenosis who underwent stent implantation were included in this study. Coronary records of all patients were monitored, and long-term clinical outcomes were recorded. The patients were divided into 2 groups according to the stenting method: focal left anterior descending stenting [ostial stenting group] and stenting from the left main coronary artery to the left anterior descending [crossover stenting group]. Results: Of the 97 eligible consecutive patients, 56 were treated with ostial stenting and 41 with crossover stenting. At a mean follow-up of 23.6 +/- 12.6 months, non-fatal myocardial infarction (3.9% vs. 12.8%, P = .118), target lesion revascularization (5.9% vs. 12.8%, P= .252), and all-cause death (2.0% vs. 7.7%, P=.191) rates were not statistically significant. However, the rate of major adverse cardiovascular events defined as a composite of non-fatal myocardial infarction, target lesion revascularization, or all-cause death was significantly higher in the crossover stenting group (8.2% vs. 28.2%, P= .013). In the multiple regression analysis, left main coronary artery diameter (odds ratio = 4.506; 95% Cl: 1.225-16.582, P=.024) and application of the crossover stenting technique (odds ratio = 5.126; 95% Cl: 1.325-19.833, P= .018) were found to be the most effective predictors of major adverse cardiovascular events. Conclusion: In our study, the ostial stenting group was associated with better clinical outcomes in the treatment of ostial left anterior descending stenosis. However, it is not appropriate to apply a single method to all patients with such lesions.