Ten-year clinical outcome of patients treated with a drug-eluting stent in the proximal left anterior descending artery segment compared with patients stented in other non-left main coronary segments

Kjøller-Hansen, Lars; Bligaard, Niels; Kelbæk, Henning; Christiansen, Evald Høj; Thuesen, Leif; Hansen, Peter Riis; Engstrøm, Thomas; Junker, Anders; Abildgaard, Ulrik; Lassen, Jens Flensted; Jensen, Jan Skov; Jeppesen, Jørgen; Galløe, Anders

doi:10.4244/eij-d-18-00396

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…In the PCI arm the risk of mortality or MACCE did not differ significantly irrespective of the involvement of a P-LAD, which is in line with recent reports, 21–23 and presumably due to the fact that lesion characteristics such as large reference vessel diameter, minimal tortuosity and higher blood flow are all favourable for PCI. Only for MI there was a statistically significant treatment-by-subgroup interaction between revascularisation strategies and a P-LAD lesion (p=0.038).…”

Section: Discussionsupporting

confidence: 90%

Mortality after multivessel revascularisation involving the proximal left anterior descending artery

Ono

Hara

Gao

et al. 2022

Heart

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ObjectiveWe sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).MethodsThis post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.ResultsAmong 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, pinteraction=0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; pinteraction=0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality.ConclusionsAmong patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG.Trial registration numberSYNTAXES:NCT03417050; SYNTAX:NCT00114972.

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Section: Discussionsupporting

confidence: 90%

Mortality after multivessel revascularisation involving the proximal left anterior descending artery

Ono

Hara

Gao

et al. 2022

Heart

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“…Also we did not have scheduled information on kidney function, another known predictor of long-term outcome [14], and that information of the left ventricular function was not available in the study database. However, a history of a previous myocardial infarction that may serve as a surrogate of a reduced left ventricular function was not a predictor of STF, only of major adverse cardiac events and cardiac death as we previously reported [8].…”

Section: Discussionmentioning

confidence: 40%

“…Data on long-term outcome derived from randomized studies and registries may be limited by inclusion of selected patients, loss to follow-up, and incomplete data on endpoints other than death. In the SORT-OUT II study, the patients included were representative of those undergoing PCI during the inclusion period, the 10-year follow-up was 99.2% complete, and all events were carefully adjudicated, as previously described [1,7,8]. So, to address some of the aforementioned issues and uncertainties to the long-term outcomes after coronary artery stenting, the main purpose of the present study was, using data from the SORT-OUT II, to demonstrate and quantitate the variation in outcomes depending on patients, lesion, and stent characteristics and to determine the predictors of the 10-year risk of stent treatment failure.…”

Section: Introductionmentioning

confidence: 99%

Predictors of 10-Year Stent-Related Adverse Outcomes after Coronary Drug-Eluting Stent Implantation: The Importance of Stent Size

et al. 2021

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Introduction: The predictors of stent treatment failure and their importance 10 years after treatment with drug-eluting stents (DESs) have not been reported in detail. Methods: Data were retrieved from the SORT-OUT II database encompassing 2,849 non-left main coronary lesions in 2,073 unselected all-comer patients treated with first-generation DES and followed clinically for 10 years. Stent treatment failure (STF) was defined as definite or probable stent thrombosis, target lesion revascularization (TLR), or >70% restenosis left untreated. Target lesion failure (TLF) was defined as cardiac death, target vessel myocardial infarction, or TLR. Characteristics predicting higher hazard ratios (HRs) were identified by the multivariate Cox regression analysis. Results: A stent diameter ≤2.5 versus ≥3.5 mm had STF 23.3 versus 11.8% and TLF 27.9 versus 18.8%. Stent length <20 versus >40 mm had STF 13.0 versus 29.0% and TLF 18.7 versus 34.6%. In multivariate analysis, decreasing stent diameter (HR: 1.24 [3.0 mm] to 2.12 [2.25 mm], reference ≥3.5 mm) and increasing stent length (HR: 1.15 [20–30 mm] to 2.07 [>40 mm], reference <20 mm) predicted STF together with diabetes (HR: 1.31), previous revascularization (HR: 1.31), restenotic (HR: 2.25), bifurcation (HR: 1.45), and chronically occluded lesions (HR: 1.54). A predictive score (PS) was calculated for each lesion from the HRs for the predictors present. The 10-year rates of STF were 10% in lesions with a PS ≤ 1.5 and 37% in those with PS ≥ 3.5. Conclusions: Ten-year outcomes show large variations depending on the stent size and a few patient and lesion characteristics. The calculation of a PS from these unambiguous variables may be used to improve the risk estimate in individual lesions and patients.

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“…The 10‐year mortality rates were similar for patients with proximal LAD and nonproximal LAD stents. The incidence of combined clinical endpoints such as cardiac death, myocardial infarction, or target revascularization was low in the proximal LAD group 9 . While these results were controversial, we can explain these differences.…”

Section: Discussionmentioning

confidence: 84%

“…The incidence of combined clinical endpoints such as cardiac death, myocardial infarction, or target revascularization was low in the proximal LAD group. 9 While these results were controversial, we can explain these differences. By comparing the risk characteristics of previous studies, we found that patients with many comorbidities or an extensive history of PCI may have received coronary artery bypass grafting instead of PCI at the time of study inclusion.…”

Section: Discussionmentioning

confidence: 88%

Association among β2‐adrenergic receptor autoantibodies and proximal left anterior descending artery lesions in patients with initial ST‐segment elevation myocardial infarction

Dang,

Cao,

Zhang

et al. 2023

Clinical Cardiology

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Backgroundβ2‐adrenergic receptor autoantibody (β2‐AA) are widely present in patients with many different types of cardiovascular diseases. Proximal left anterior descending (LAD) artery lesions are associated with adverse prognostic events in patients with ST‐segment elevation myocardial infarction (STEMI).Hypothesisβ2‐AA is associated with the presence of proximal LAD lesions in patients with STEMI.MethodsA cohort of 153 patients with STEMI who underwent primary percutaneous coronary intervention (PPCI) was enrolled in the study. Baseline characteristics were compared between the proximal LAD group (n = 62) and the nonproximal LAD group (n = 91). Admission serum of patients was collected to detect the level of β2‐AA. Data for echocardiogram within 24 hours after PPCI and at the 6‐month follow‐up were recorded.ResultsThe optical density values and positive rates of β2‐AA in the proximal LAD group were higher than those in the nonproximal LAD group (p < 0.05). β2‐AA positively correlated with high sensitivity C‐reactive protein and peak N‐terminal pro‐B type natriuretic peptide levels in the proximal LAD group, but those were not relevant in the nonproximal LAD group. Multivariate logistic regression analysis revealed that high β2‐AA levels was independently associated with the presence of proximal LAD lesions in patients with STEMI. Furthermore, a receiver operating characteristic curve was used to show the efficiency of β2‐AA levels to detect proximal LAD lesions, and the AUC of the β2‐AA OD value was 0.658 (95% confidence interval 0.568−0.749; p = 0.001).ConclusionsThe STEMI patients with high β2‐AA levels had a greater possibility having proximal LAD lesions.

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Ten-year clinical outcome of patients treated with a drug-eluting stent in the proximal left anterior descending artery segment compared with patients stented in other non-left main coronary segments

Cited by 9 publications

References 18 publications

Mortality after multivessel revascularisation involving the proximal left anterior descending artery

Mortality after multivessel revascularisation involving the proximal left anterior descending artery

Predictors of 10-Year Stent-Related Adverse Outcomes after Coronary Drug-Eluting Stent Implantation: The Importance of Stent Size

Association among β2‐adrenergic receptor autoantibodies and proximal left anterior descending artery lesions in patients with initial ST‐segment elevation myocardial infarction

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