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Aorto-Ostial Lesion Percutaneous Coronary Intervention: Clinical Characteristics, Predictors and Clinical Outcomes

Simon M Thackray1, Riley J Batchelor1,2,3, Diem Dinh2

  • 1Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 18, 2026
PubMed

Insights

Percutaneous coronary intervention (PCI) for aorto-ostial lesions (AOL) in high-risk patients showed similar early outcomes but lower long-term survival, primarily driven by right coronary artery (RCA) interventions.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Aorto-ostial coronary lesions pose unique challenges for percutaneous coronary intervention (PCI) due to complex anatomy and potential for poor outcomes.
  • Ostial left main coronary artery (LMCA) and right coronary artery (RCA) lesions present distinct anatomical considerations and myocardial territory at risk.

Purpose of the Study:

  • To compare procedural practices and clinical outcomes between aorto-ostial lesions (AOL) and proximal non-ostial lesions in LMCA and RCA.
  • To identify predictors of 30-day major adverse cardiovascular events (MACE) in patients undergoing PCI for AOL.

Main Methods:

  • Analysis of a multicentre registry (2005-2020) comparing patients with AOL (ostial LMCA/RCA) versus non-AOL (proximal non-ostial LMCA/RCA).
  • Primary outcome: long-term mortality. Secondary outcomes: in-hospital and 30-day MACE.
  • Multivariable logistic regression and vessel-specific analyses were employed.

Main Results:

  • The AOL group (11.5%) had higher baseline risk (older, more females, comorbidities, complex lesions) compared to the non-AOL group.
  • Aorto-ostial lesion location was not an independent predictor of 30-day MACE (adjusted OR 0.93).
  • Pooled long-term survival was lower in the AOL cohort; vessel-specific analysis revealed no difference for LMCA PCI but lower survival for ostial RCA PCI.

Conclusions:

  • Patients undergoing AOL PCI exhibit a higher-risk profile but comparable early procedural safety and outcomes.
  • The observed difference in long-term survival is largely attributed to the RCA cohort, suggesting baseline risk rather than solely periprocedural factors.
  • No significant difference in outcomes between ostial and non-ostial LMCA PCI was noted.
Abstract

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