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Treatment of Ostial Right Coronary Artery Narrowings: Outcomes From the Multicenter Prospective e-ULTIMASTER Registry

Yaniv Levi1, Ofer Kobo1, Majdi Halabi2

  • 1Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel.

Journal of the Society for Cardiovascular Angiography & Interventions
|August 12, 2024
PubMed

Insights

Current drug-eluting stents (DES) show feasible treatment for right coronary artery (RCA) aorto-ostial (AO) lesions, with similar target lesion failure (TLF) rates. However, increased risks of target vessel revascularization and stent thrombosis were observed in RCA-AO stenting.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Previous treatments for right coronary artery (RCA) aorto-ostial (AO) lesions using bare-metal stents and first-generation drug-eluting stents (DES) were linked to poorer patient outcomes.
  • Current-generation DES offer potential improvements for complex coronary interventions.

Purpose of the Study:

  • To evaluate the clinical outcomes of stenting RCA-AO lesions using current-generation DES.
  • To compare the efficacy and safety of RCA-AO stenting versus proximal RCA stenting.

Main Methods:

  • The e-ULTIMASTER registry, a large, multicontinental study, included 37,198 patients undergoing percutaneous coronary intervention (PCI).
  • A cohort of 4775 patients received the Ultimaster stent for ostial and proximal RCA PCI.
  • The primary endpoint was 1-year target lesion failure (TLF), defined as cardiac death, target vessel myocardial infarction, or clinically indicated target lesion revascularization.

Main Results:

  • A comparison between 591 RCA-AO PCI patients and 4184 proximal RCA PCI patients revealed that the RCA-AO group had more comorbidities and complex coronary anatomy.
  • After propensity matching, TLF rates were similar (4.49% vs. 3.00%, P=.06).
  • However, RCA-AO stenting was associated with significantly higher rates of target vessel revascularization (3.29% vs. 1.90%, P=.03) and stent thrombosis (1.23% vs. 0.42%, P=.01) compared to proximal RCA stenting.

Conclusions:

  • Percutaneous coronary intervention for RCA-AO lesions using current-generation DES is technically feasible.
  • While overall target lesion failure rates are comparable to proximal RCA stenting, there is an elevated risk of target vessel revascularization and stent thrombosis in RCA-AO lesions.
Abstract

Keywords:
ostial lesionpercutaneous coronary interventionright coronary artery

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