Author + information
- Received June 25, 2019
- Revision received October 7, 2019
- Accepted November 5, 2019
- Published online April 6, 2020.
- Ariel Roguin, MD, PhDa,∗,
- Rosaly A. Buiten, MDb,c,∗,
- Carine J.M. Doggen, PhDc,
- Ofer Kobo, MDa,
- Paolo Zocca, MDb,c,
- Peter W. Danse, MD, PhDd,
- Carl E. Schotborgh, MDe,
- Gillian A.J. Jessurun, MD, PhDf,
- K. Gert van Houwelingen, MDb,
- Martin G. Stoel, MD, PhDb,
- R. Melvyn Tjon Joe Gin, MDd,
- Gerard C.M. Linssen, MD, PhDg and
- Clemens von Birgelen, MD, PhDb,c,∗ ()
- aDepartment of Cardiology, Hillel Yaffe Medical Center, Hadera and B. Rappaport-Faculty of Medicine, Israel Institute of Technology, Haifa, Israel
- bDepartment of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
- cDepartment of Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- dDepartment of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands
- eDepartment of Cardiology, Haga Hospital, The Hague, the Netherlands
- fDepartment of Cardiology, Treant Zorggroep, Scheper Hospital, Emmen, the Netherlands
- gDepartment of Cardiology, Hospital Group Twente, Almelo and Hengelo, the Netherlands
- ↵∗Address for correspondence:
Dr. Clemens von Birgelen, Department of Cardiology, Medisch Spectrum Twente, P.O. Box 50000, 7500 KA Enschede, the Netherlands.
Objectives This study sought to assess 2-year clinical outcome following percutaneous coronary intervention (PCI) with thin-strut new-generation drug-eluting stents (DES) in patients treated in proximal left anterior descending artery (P-LAD) versus non–P-LAD lesions.
Background In current revascularization guidelines, P-LAD coronary artery stenosis is discussed separately, mainly because of a higher adverse event risk and benefits of bypass surgery.
Methods The study included 6,037 patients without previous bypass surgery or left main stem involvement from the TWENTE I, II, and III randomized trials. A total of 1,607 (26.6%) patients had at least 1 DES implanted in P-LAD and were compared with 4,430 (73.4%) patients who were exclusively treated in other (non–P-LAD) segments.
Results Two-year follow-up was available in 5,995 (99.3%) patients. At baseline, P-LAD patients had more multivessel treatment and longer total stent length. The rate of the patient-oriented composite clinical endpoint (any death, any myocardial infarction, or any revascularization) was similar in P-LAD versus non–P-LAD patients (11.4% vs. 11.6%; p = 0.87). In P-LAD patients, the rate of the device-oriented composite clinical endpoint (cardiac death, target vessel myocardial infarction, or target lesion revascularization) was higher (7.6% vs. 6.0%; p = 0.020), driven by a higher rate of target vessel myocardial infarction (4.1% vs. 2.6%; p = 0.002). However, multivariate analysis showed no independent association between stenting P-LAD lesions and clinical endpoints.
Conclusions In this patient-level pooled analysis of 3 large-scale contemporary DES trials, treatment of P-LAD lesions was not independently associated with higher 2-year adverse clinical event rates. These results imply that separate consideration in future revascularization guidelines may not be mandatory any longer.
- drug-eluting stents
- percutaneous coronary intervention
- proximal left anterior descending
- randomized clinical trial
↵∗ Drs. Roguin and Buiten contributed equally to this work.
Dr. von Birgelen has received institutional research grant support from Abbott Vascular, Biotronik, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 25, 2019.
- Revision received October 7, 2019.
- Accepted November 5, 2019.
- 2020 American College of Cardiology Foundation
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