Cor Vasa 2024, 66(1):29-36 | DOI: 10.33678/cor.2023.085

Clinical Outcomes of Isolated Non-Left Main Side Branch Ostial Stenosis: Medical Therapy versus Percutaneous Coronary Intervention (the ALP-SBO registry)

Serkan Kahraman, Ahmet Guner, Fatih Uzun, Ali Kemal Kalkan, Mustafa Ali Yavas, Mehmet Cicek, Taner Sahin, Cemalettin Akman, Omer Celik, Mehmet Ertruk

University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Department of Cardiology, Training and Research Hospital, Istanbul, Turkey

Aim: Side branch (SB) ostial stenosis is a frequent bifurcation lesion and its optimal treatment strategy is still debated. Although the efficacy of the optimal medical therapy is well known, the comparison of the medical treatment and percutaneous coronary intervention (PCI) is controversial.

Methods: A total of 357 consecutive patients with isolated SB ostial stenosis (Medina 0.0.1 classification) was evaluated retrospectively. Patients were divided into two groups; patients with only medical therapy (n = 305) and patients undergoing PCI (n = 52). Target vessel revascularization (TVR), myocardial infarction (MI), and mortality were evaluated as major adverse cardiovascular outcomes (MACE).

Results: The mean age of the patients was 58.2±10.3 years. 102 patients (28.6%) were female. 279 patients (78.2%) had diagonal lesion while 78 (21.8%) had obtuse marginal lesion. The SB stenosis ratio (70±16; 88±13, p < 0.001) and SB lesion length (7.5±6.6; 14.7±6.0, p < 0.001) were higher in the PCI group. SB ostial stenting (38 patients [73.1%]) was the common PCI technique. There were no significant differences in terms of TVR (1.3%; 1.9%, p = 0.277, medical vs PCI groups, respectively), MI (8.2%; 7.7%, p = 0.302, medical vs PCI groups, respectively), mortality (10.2%; 9.6%, p = 0.095, medical vs PCI groups, respectively) and MACE (18.0%; 15.4%, p = 0.113, medical vs PCI groups, respectively) between groups. Additionally, in Kaplan-Meier long-term survival analysis, there were no differences in TVR (log-rank p = 0.247), MI (log-rank p = 0.295), mortality (log-rank p = 0.086), and MACE (log-rank p = 0.107) between groups.

Conclusions: Medical therapy instead of PCI seems to be an appropriate and optimal treatment strategy in patients with non-left main SB ostial stenosis.

Keywords: Coronary bifurcation lesion, Percutaneous coronary intervention, Ostial stenosis, Side branch,

Received: October 16, 2023; Revised: November 19, 2023; Accepted: November 21, 2023; Prepublished online: June 2, 2012; Published: March 5, 2024  Show citation