Crossover Versus Ostial Single-stent Implantation for Ostial Left Circumflex Artery Lesions: The Multicenter CROSS-LCX Registry.

BACKGROUND

To date, the optimal revascularization strategy for patients with ostial left circumflex artery (LCX) lesions has not been established. In this study we sought to assess the cardiovascular outcomes of the crossover stent implantation (CSI) and ostial stent implantation (OSI) for the ostial LCX lesions under long-term follow-up.

METHODS

This large-scale, multicenter (n = 12), observational retrospective study included 414 patients (290 [70%] men and 124 women, mean age 64.95 ± 11.73 years) who underwent PCI with CSI or OSI for ostial LCX lesions between 2014 and 2025. The primary outcome was major adverse cardiac events (MACE), including cardiac death, target lesion revascularization, and target vessel myocardial infarction.

RESULTS

The study cohort was divided into 2 groups as OSI (n = 212) and CSI (n = 202). SYNTAX scores and the use of intravascular imaging rates were similar in both groups. Side-branch (left anterior descending artery) interventions were more frequent in the CSI group compared with OSI, with higher rates of side-branch ballooning (36.1% vs 2.8%, P < 0.001) and bailout 2-stent implantation (13.9% vs 5.7%, P = 0.005). The risk-adjusted long-term MACE (hazard ratio [HR] 0.357, P = 0.001), major adverse cardiac and cerebral events (HR 0.397, P = 0.001) significantly differed in individuals with ostial LCX lesions to revascularize with CSI and OSI. In addition, diabetes mellitus, chronic kidney disease, intravascular imaging, reduced left ventricle ejection fraction, high SYNTAX score, and direct stenting were found to be independent predictors of MACE.

CONCLUSIONS

The findings from this study suggest that CSI was associated with lower risk-adjusted MACE and MACCE rates, whereas the CSI technique leads to notably higher side-branch interventions.