Why the study?
The extent of jeopardized myocardium in patients with single vessel coronary artery disease of variable severity and location was not well quantified.
Does a drug-coated balloon-based treatment strategy reduce major adverse cardiovascular events compared to a drug-eluting stent-only strategy in patients with de novo left anterior descending coronary artery lesions?
Cohort (n=4,415)
Yes
Does a drug-coated balloon-based treatment strategy reduce major adverse cardiovascular events compared to a drug-eluting stent-only strategy in patients with de novo left anterior descending coronary artery lesions?
Hazard Ratio: 0.5 (95% CI 0.28–0.9)
Absolute Event Rate: 4.5% vs 7.6%
p-value: p=0.020
A drug-coated balloon-based strategy offers a safe, stent-sparing alternative that significantly reduces long-term MACE and bleeding events compared to a conventional DES-only approach for de novo LAD lesions.
To assess the extent of jeopardized myocardium in patients with single vessel coronary artery disease of variable severity and location, quantitative exercise thallium-201 single photon emission computed tomography was performed in 158 consecutive patients with angiographically proved single vessel coronary artery disease. The extent of abnormal left ventricular perfusion was quantified from computer-generated polar maps of three-dimensional myocardial radioactivity. Patients with only a moderate (51% to 69%) stenosis tended to have a small perfusion defect irrespective of the coronary artery involved. Whereas a perfusion defect measuring greater than or equal to 10% of the left ventricle was found in 78% of patients with no prior infarction and severe (greater than or equal to 70%) stenosis, this was observed in only 24% of patients with moderate stenosis. Perfusion defect size increased with increasing severity of stenosis for the entire group without infarction and for those with left anterior descending, right and circumflex coronary artery stenosis. However, the correlation between stenosis severity and perfusion defect size was at best only modest (r = 0.38, p = 0.0001). The left anterior descending artery was shown to be the most important of the three coronary arteries for providing left ventricular perfusion. Proximal stenosis of this artery produced a perfusion defect approximately twice as large as that found in patients with a proximal right or circumflex artery stenosis. However, marked heterogeneity in perfusion defect size existed among all three vessels despite comparable stenosis severity. This was most apparent for the left anterior descending coronary artery, where mid vessel stenosis commonly produced a perfusion defect similar in size to that found in proximally stenosed vessels.(ABSTRACT TRUNCATED AT 250 WORDS)
No takes yet. Share an insight, caveat, or question.
Mahmarian et al. (1991) conducted a cohort in De novo left anterior descending (LAD) coronary artery lesions (n=4,415). Drug-coated balloon (DCB) based treatment vs. Drug-eluting stent (DES) only strategy was evaluated on Major adverse cardiovascular events (MACE: composite of cardiac death, non-fatal MI, TVR, definite target lesion thrombosis, and major bleeding) (HR 0.50, 95% CI 0.28-0.90, p=0.020).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: