Ostial vs proximal stenting in LAD stenosis: A comparative study

BACKGROUND: Proximal left anterior descending (LAD) artery disease is associated with adverse clinical outcomes. Ostial proximal LAD (O-pLAD) lesions represent a technically challenging subset, yet data comparing outcomes with non-ostial proximal LAD (NO-pLAD) lesions are limited. This study aimed to compare 2-year clinical outcomes following percutaneous coronary intervention (PCI) for O-pLAD versus NO-pLAD lesions. METHODS: We conducted a single-center retrospective cohort study including patients who underwent PCI of a significant proximal LAD lesion between June 2017 and September 2023. O-pLAD stenosis was defined as ≥70% diameter stenosis within 5 mm of the LAD ostium; NO-pLAD lesions were defined as ≥70% stenosis distal to this segment and proximal to the first major septal or diagonal branch. The primary endpoint was target lesion failure (TLF), a composite of target lesion revascularization (TLR), target vessel myocardial infarction, and cardiac death, assessed at a maximum follow-up of 730 days. Multivariable Cox regression was performed to adjust for relevant clinical and procedural confounders. RESULTS: A total of 1229 patients were included (522 O-pLAD, 707 NO-pLAD). Patients with O-pLAD lesions were older and had more multivessel disease and lesion calcification. At median follow-up of 730 days, TLF occurred more frequently in the O-pLAD group than in the NO-pLAD group (14.6% vs. 7.9%). NO-pLAD lesions were associated with significantly lower TLF after IPTW weighted analyis. TLR was significantly lower in the NO-pLAD group and remained so after adjustment. No significant differences were observed in cardiac death, target-vessel myocardial infarction, or major adverse cardiovascular events. CONCLUSIONS: Compared with ostial proximal LAD lesions, non-ostial proximal LAD stenting is associated with lower rates of target lesion failure and target lesion revascularization at 2 years. Ostial involvement may be an important consideration when selecting revascularization strategies for proximal LAD disease.