Proximal Left Anterior Descending Artery Stenting. Should it be Treated Differently than Other Segment of the Coronary Tree?

Background: Proximal Left Descending Artery (pLAD) lesions are considered uniquely in the revascularization guidelines. The aim of the study was to report the clinical outcomes of patients treated with a third generation thin-strut drug-eluting stent (DES), according to pLAD Vs. non pLAD locations.

Methods: Data from a large, international real-world registry (e-Ultimaster) were used to perform a subgroup analysis of patients undergoing percutaneous coronary intervention (PCI). Multivariate analysis as well as propensity score methodology was used to adjust for any baseline differences. The primary outcome was target lesion failure (TLF) (composite of cardiac death, target lesion related MI clinically driven TLR) at 1 year follow up.

Results: There were 3635 [30.4%] patients (6938 lesions) in the pLAD group and this group was compared to 8308 [69.6%] patients (14796 lesions) in which stenting of other lesion(s) but not the pLAD was performed. There was no statistically significant difference in the occurrence of the primary endpoint of TLF at 12 months between pLAD and non pLAD lesions [n=129, 5.6% Vs. n=239, 2.9%; p=0.057], one year mortality (2.4% Vs 2.2%, p=0.55) or MI rate (1.02% Vs 1.05%, p=0.92] . The proximal LAD group had higher rates of TVF (4.1% Vs. 3.4%, p=0.033) and MACE (4.3% Vs 3.5% p=0.042) due to higher rates of revascularization (TLR 1.79% (65/3635) Vs. 1.2% (100/8308), p=0.013). Multivariate analyses found that proximal LAD location was not a predictor for events. After propensity matched analysis, one-year incidence of target lesion failure (TLF) was similar in both groups.

Conclusion: Patients had comparable clinical outcomes independent of stenting location. Stenting of the proximal LAD did not confer a different prognosis, questioning whether indeed it should be regarded differently from stenting of any other coronary artery segment