Author + information
- Received November 11, 2016
- Accepted December 16, 2016
- Published online March 20, 2017.
- Ariel Roguin, MD, PhDa,b,∗ (, )
- Edoardo Camenzind, MDc,d,
- Arthur Kerner, MDa,b,
- Rafael Beyar, MD, DsCa,b,
- Eric Boersma, MDe,
- Laura Mauri, MDf,
- Ph. Gabriel Steg, MDg,h,i,j and
- William Wijns, MDk
- aRambam Medical Center, Haifa, Israel
- bTechnion–Israel Institute of Technology, Haifa, Israel
- cInstitut Lorrain du Coeur et des Vaisseaux, Vandoeuvre-les-Nancy, France
- dUniversité de Lorraine, Nancy, France
- eErasmus Medical Center, Rotterdam, the Netherlands
- fHarvard Medical School, and Brigham and Women’s Hospital, Boston, Massachusetts
- gDépartement Hospitalo-Universitaire FIRE, Paris, France
- hUniversité Paris-Diderot, Sorbonne-Paris Cité, Paris, France
- iAssistance Publique - Hôpitaux de Paris, Hôpital Bichat, Paris, France
- jNHLI Imperial College, ICMS, Royal Brompton Hospital, London, United Kingdom
- kCardiovascular Research Center, OLV Hospital, Aalst, Belgium
- ↵∗Address for correspondence:
Dr. Ariel Roguin, Rambam Medical Center, Haifa, Israel, Technion-Israel Institute of Technology 7 Efron Street, Bat Galim, Haifa 31096, Israel.
Objectives This study sought to compare the outcomes of patients undergoing drug-eluting stent implantation according to lesion location within or outside the proximal left anterior descending (LAD) artery.
Background Proximal LAD artery involvement is considered uniquely in revascularization guidelines. The impact of LAD lesion location on long-term outcomes after revascularization is poorly understood in context of current percutaneous coronary intervention and medical therapy.
Methods Among 8,709 patients enrolled in PROTECT (Patient Related Outcomes with Endeavor Versus Cypher Stenting Trial), a multicenter percutaneous coronary intervention trial, we compared the outcomes of 2,534 patients (29.1%) (3,871 lesions [31.5%]) with stents implanted in the proximal LAD to 6,172 patients (70.9%) (8,419 lesions [68.5%]) with stents implanted outside the proximal LAD.
Results At the 4-year follow-up, death rates were the same (5.8% vs. 5.8%; p > 0.999), but more myocardial infarctions occurred in the proximal LAD group (6.2% vs. 4.9%; p = 0.015). The rate of clinically driven target vessel failure (TVF) (14.8% vs. 13.5%; p = 0.109), major adverse cardiac event(s) (MACE) (15.0% vs. 13.7%; hazard ratio: 1.1; 95% confidence interval: 0.97 to 1.31; p = 0.139), and stent thrombosis (2.1% vs. 2.0%; p = 0.800) were similar. Drug-eluting stent type had no interaction with MACE or TVF. In multivariate analysis, the proximal LAD was a predictor of myocardial infarction (p = 0.038) but not of TVF (p = 0.149) or MACE (p = 0.069).
Conclusions In this study of contemporary percutaneous coronary intervention, proximal LAD location was associated with higher rates of myocardial infarction during the long-term follow-up, but there were no differences in stent thrombosis, death, TVF, or overall MACE. This finding may suggest that, in the drug-eluting stent era, proximal LAD no longer confers a different prognosis than other lesion sites. (Randomized Study Comparing Endeavor With Cypher Stents [PROTECT]; NCT00476957)
The PROTECT trial was supported by Medtronic. Dr. Boersma has received grants and personal fees from Medtronic, Servier, and Sanofi for study-related activities. Dr. Mauri has received grants from Medtronic during the conduct of the study; and grants from Abbott, Cordis, Boston Scientific, Medtronic, Eli Lilly/Daiichi-Sankyo, and Bristol Myers. Dr. Steg has received personal fees from Medtronic during the conduct of the study; personal fees from Amarin, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, GlaxoSmithKline, Lilly, Merck-Sharpe-Dohme, Novartis, Otsuka, Pfizer, Roche, The Medicines Company, and Vivus outside the submitted work; and grants and personal fees from Sanofi and Servier outside the submitted work. Dr. Wijns has received grants from Medtronic and Cordis J&J during the conduct of the study; grants from Boston Scientific, Biosensors, Terumo, MI-CELL, Pfizer, and Boehringer Ingelheim outside the submitted work; grants and non-financial support from Abbott Vascular, AstraZeneca, Biotronik, Cardio3 BioSciences, and St. Jude outside the submitted work; non-financial support from Volcano outside the submitted work; and has served as non-executive board member and stockholder of Cardio3 BioSciences (now Celyad), Argonauts, and Genae Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 11, 2016.
- Accepted December 16, 2016.
- 2017 American College of Cardiology Foundation