Outcomes After Percutaneous Coronary Intervention of Ostial Lesions in the Era of Drug-Eluting Stents Melanie Freeman, 1 MBBS, FRACP , David J. Clark, 1 * MBBS, FRACP , Nick Andrianopoulos, 2 MBBS, MBIOSTAT , Stephen J. Duffy, 3 MBBS, PhD, FRACP , MRCP , FCSANZ, Han S. Lim, 1 MBBS, Angela Brennan, 2 RN, CCRN, Kerrie Charter, 1 RN, CCRN, James Shaw, 3 MBBS, PhD, FRACP , Mark Horrigan, 1 MBBS, FRACP , Andrew E. Ajani, 4,6 MBBS, FRACP , FJFICM, MD, Martin Sebastian, 5 MBBS, FRACP , FCSANZ, Christopher M. Reid, 2 BA, MSC, DIP ED, PHD, and H.M. Omar Farouque, 1 MBBS (Hons) , FRACP , PHD, FACC, FCSANZ on behalf of the Melbourne Interventional Group Background: Ostial lesions are a difficult subset associated with suboptimal outcomes after percutaneous coronary intervention (PCI). The aim of this study was to analyze outcomes of ostial lesions in contemporary Australian interventional practi- ce. Methods: The study population comprised 1,713 consecutive patients who under- went PCI for proximal lesions of the left anterior descending, left circumflex, and right coronary arteries, who were prospectively enrolled in the Melbourne Interventional Group Registry (February 2004–December 2006). We compared the in-hospital, 30-day, and 1-year outcomes of the 109 patients undergoing PCI for ostial, with the 1,604 patients with proximal nonostial lesions. Left main and bifurcation lesions were exclu- ded. Results: Patients in the ostial group were older (mean age 68.8 6 11 vs. 64.9 6 12 years; P 5 0.001), and there was a greater proportion of women (38.5% vs. 28.0%; P 5 0.021). Other clinical characteristics were similar. The nonostial group were more likely receive a stent (94.6% vs. 87.2%; P 5 0.005) but drug-eluting stents (DES) were deployed more often in the ostial group (47.9% vs. 66.1%; P < 0.0001). There was lower procedural success, with no significant difference in in-hospital death, bleeding or emergency PCI, but unplanned in-hospital coronary artery bypass grafting was more frequent in the ostial group (4.8% vs. 1.0%; P 5 0.007). There was no difference in 30-day major adverse cardiac events. However, 12-month death (8.8% vs. 4%, log rank P 5 0.032) and MACE (24.2% vs. 13.8%, log rank P 5 0.005) were higher in the ostial group than the nonostial group with trends to increased incidence of myocardial in- farction (6.6% vs. 4.7%, P 5 NS), and target vessel revascularization (13.2% vs. 7.9%, P 5 NS). Conclusion: In contemporary, Australian interventional practice, PCI for ostial lesions is associated with a high incidence of adverse outcome at one year despite the introduction of DES. ' 2009 Wiley-Liss, Inc. Key words: coronary artery disease; coronary atherosclerosis; ischemic heart disease; angioplasty 1 Department of Cardiology, Austin Hospital 2 Monash Centre for Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University 3 Alfred Hospital 4 Royal Melbourne Hospital 5 Geelong Hospital 6 University of Melbourne, Victoria, Australia Conflict of interest: The Melbourne Interventional Group acknowl- edges funding from Abbott Vascular, AstraZeneca, Biotronik, Boston Scientific, Johnson & Johnson, Medtronic, Pfizer, Schering- Plough, Sanofi-Aventis, Servier, St. Jude Medial, and Terumo. These companies do not have access to the data, and do not have the right to review articles before publication. Dr. Duffy’s work is supported by a National Health and Medical Research Council of Australia Program Grant. *Correspondence to: Dr. David J. Clark, Austin Health, Cardiology Department, PO Box 5555, 145 Studley Road, Heidelberg, Melbourne, Victoria 3084, Australia. E-mail: clarkdavidj@hotmail.com Received 16 September 2008; Revision accepted 17 November 2008 DOI 10.1002/ccd.21941 Published online 23 March 2009 in Wiley InterScience (www. interscience.wiley.com). ' 2009 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 73:763–768 (2009)