Outcomes of Ostial vs. Non-Ostial LAD Lesions in Acute AWMI Treated with Primary PCI

Abstract

Objectives: This study aims to assess the differential risk profiles of patients with ostial versus non-ostial left anterior descending (LAD) lesions in acute anterior wall myocardial infarction (AWMI). Key parameters evaluated include procedural success, in-hospital complications, and major adverse cardiac events (MACE) to guide tailored interventional strategies. Methodology: This prospective, cross-sectional study included patients with acute AWMI treated with primary percutaneous coronary intervention (PPCI). Patients were categorized based on lesion location into either the ostial or non-ostial LAD lesion group. Clinical outcomes, including procedural success, in-hospital complications, and MACE, were compared between the two groups. Results: Among 370 patients (mean age: 54.9 ± 8.6 years; 294 [79.5%] male), 101 (27.3%) had ostial LAD lesions. Patients with ostial LAD lesions had a higher prevalence of Killip class IV (9.9% vs. 2.2%) and required intubation more frequently (22.8% vs. 4.5%; p ≤ 0.001). Complete vessel occlusion was observed in 80.2% vs. 61%, and thrombus grade V was detected in 75.2% vs. 58.4% in the ostial LAD group compared to the non-ostial LAD group, respectively. The incidence of slow-flow/no-reflow was significantly higher in the ostial LAD group (17.8% vs. 6.3%), with a higher rate of table death (5% vs. 1.5%; p=0.02). Ostial LAD lesions were associated with higher rates of in-hospital MACE, including heart failure (40.6% vs. 22.7%, p = 0.001), myocardial infarction (18.8% vs. 4.1%, p < 0.001), and cardiogenic shock (20.8% vs. 4.8%, p < 0.001). Arrhythmias were also more frequent (46.5% vs. 27.1%, p < 0.001). Conclusion: Patients with AWMI and ostial LAD culprit lesions exhibited a higher-risk clinical profile, characterized by greater procedural complexity, increased hemodynamic compromise, and higher in-hospital MACE rates compared to non-ostial LAD lesions. These findings underscore the need for specialized interventional strategies to improve outcomes.