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J Am Coll Cardiol, 2004; 44:967-971, doi:10.1016/j.jacc.2004.05.058
© 2004 by the American College of Cardiology Foundation
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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{dagger}, Giuseppe M. Sangiorgi, MD*, Matteo Montorfano, MD{dagger}, Flavio Airoldi, MD{dagger}, Alaide Chieffo, MD{dagger}, Goran Stankovic, MD*, Giancarlo Vitrella, MD{dagger}, Mauro Carlino, MD{dagger}, Nicola Corvaja, MD*, Carlo Briguori, MD{dagger} and Antonio Colombo, MD*,*

* Centro Cuore Columbus
{dagger} 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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