Key result
Proximal LAD PCI shows similar 1-year target lesion failure rates versus nonproximal LAD PCI.
Why the study?
Guidelines recommend heart team discussion and coronary artery bypass graft consideration in proximal LAD stenosis, but evidence suggests outcomes of proximal LAD angioplasty may not differ from nonproximal LAD treatment.
Does percutaneous coronary intervention in the proximal LAD segment result in different rates of target lesion failure compared to nonproximal LAD angioplasty?
Observational (n=17,805)
Yes
Does percutaneous coronary intervention in the proximal LAD segment result in different rates of target lesion failure compared to nonproximal LAD angioplasty?
Odds Ratio: 1.07 (95% CI 0.88–1.31)
Absolute Event Rate: 3.3% vs 2.9%
p-value: p=0.48
PCI in the proximal LAD segment using a thin-strut drug-eluting stent yields similar 1-year clinical outcomes compared to nonproximal LAD stenting, suggesting proximal LAD disease may not inherently require different revascularization strategies.
May support equivalent proximal LAD PCI outcomes without special strategies; extends observational data but leaves open randomized confirmation.
Background Guidelines recommend heart team discussion and coronary artery bypass graft consideration in patients with proximal left anterior descending ( LAD ) artery stenosis. Evidence suggests that outcomes of proximal LAD angioplasty might not differ from treatment of nonproximal LAD locations. We aim to determine clinical outcomes of patients undergoing percutaneous coronary intervention in the proximal LAD segment in comparison with nonproximal LAD angioplasty, using a thin‐strut drug‐eluting stent. Methods and Results In this analysis of the e‐Ultimaster registry, patients undergoing angioplasty in the proximal LAD territory were compared with those treated in nonproximal LAD locations. Multivariate analysis and propensity score were used to adjust for differences among the groups. The primary outcome was target lesion failure: a composite of cardiac death, target‐lesion–related myocardial infarction, and/or clinically driven target lesion revascularization at 1‐year follow‐up. Of the 17 805 patients (mean age, 64.2±11; 76% male), 5452 (30.6%) underwent proximal LAD and 12 353 (69.4%) nonproximal LAD percutaneous coronary intervention. Patients in the proximal LAD group had more multivessel disease (48.7% versus 43.5%; P <0.001) and 2‐fold more bifurcations lesions (18.8% versus 9.2%; P <0.0001). After propensity‐weighted adjustment, target lesion failure did not differ between the groups (3.3% versus 2.9%; P =0.17 for proximal LAD versus nonproximal LAD angioplasty, respectively). In multivariate analysis, proximal LAD treatment was not an independent predictor of target lesion failure (odds ratio, 1.07; 95% CI, 0.88–1.31; P =0.48). Conclusions At 1‐year follow‐up, patients had similar clinical outcomes independent of stenting location, questioning whether proximal LAD treatment should be regarded differently from stenting in any other coronary artery territory.
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Codner et al. (2019) conducted an observational in Left anterior descending (LAD) artery stenosis (n=17,805). Proximal LAD percutaneous coronary intervention vs. Nonproximal LAD percutaneous coronary intervention was evaluated on Target lesion failure: a composite of cardiac death, target-lesion-related myocardial infarction, and/or clinically driven target lesion revascularization at 1-year follow-up (OR 1.07, 95% CI 0.88-1.31, p=0.48). Proximal LAD percutaneous coronary intervention had similar 1-year rates of target lesion failure compared to nonproximal LAD intervention (3.3% vs 2.9%; OR 1.07, 95% CI 0.88-1.31; P=0.48).
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