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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Clinical and angiographic outcome after sirolimus-eluting stent implantation in aorto-ostial lesions

Ioannis Iakovou, MD^*, Lei Ge, MD^*, Iassen Michev, MD, Giuseppe M. Sangiorgi, MD^*, Matteo Montorfano, MD, Flavio Airoldi, MD, Alaide Chieffo, MD, Goran Stankovic, MD^*, Giancarlo Vitrella, MD, Mauro Carlino, MD, Nicola Corvaja, MD^*, Carlo Briguori, MD and Antonio Colombo, MD^*,*

^* Centro Cuore Columbus
San Raffaele Hospital, Milan, Italy

Manuscript received April 9, 2004; revised manuscript received May 10, 2004, accepted May 18, 2004.

^* Reprint requests and correspondence: Dr. Antonio Colombo, EMO Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy (Email: info{at}emocolumbus.it).

OBJECTIVES: This observational study evaluated the clinical and angiographic outcomes of patients with aorto-ostial coronary artery disease treated with sirolimus-eluting stents (SESs) or with bare metal stents (BMSs).

BACKGROUND: The safety and effectiveness of SESs for the treatment of aorto-ostial lesions have not been demonstrated.

METHODS: We identified 82 consecutive patients who underwent percutaneous coronary interventions in 82 aorto-ostial lesions using the SES (32 patients) or BMS (50 patients) and compared the two groups of patients. The incidence of major adverse cardiac events (MACE), including death or Q-wave myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR), were recorded in-hospital and at a 10-month follow-up.

RESULTS: All stents were implanted successfully. There were no statisticallysignificant differences regarding major in-hospital complications between the two groups. At 10-month follow-up, two (6.3%) patients in the SES group and 14 (28%) patients in the BMS group underwent TLR (p = 0.01); MACE were less frequent in the SES group compared to the BMS group (19% vs. 44%, p = 0.02). Angiographic follow-up showed lower binary restenosis rates (11% vs. 51%, p = 0.001) and smaller late loss (0.21 ± 0.31 mm vs. 2.06 ± 1.37 mm, p < 0.0001) in the SES group.

CONCLUSIONS: The main finding of our study is that, compared to the BMS, implantation of the SES in aorto-ostial lesions appears safe and effective, with no increase in major in-hospital complications and a significant improvement in restenosis and late event rates at 10-month follow-up.

Abbreviations and Acronyms   BMS = bare metal stent   DS = diameter stenosis   MACE = major adverse cardiac events   MI = myocardial infarction   MLD = minimal lumen diameter   PTFE = polytetrafluoroethylene   SES = sirolimus-eluting stent   TLR = target lesion revascularization   TVR = target vessel revascularization

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