TY - JOUR
T1 - Should Proximal LAD be treated differently? Insights from a large DES stent registry
AU - Kerner, Arthur
AU - Abergel, Eitan
AU - Halabi, Majdi
AU - Soni, Amit
AU - Danzi, Gian Battista
AU - Yalonestky, Sergey
AU - Spaepen, Erik
AU - Paunovic, Dragica
AU - Nikolsky, Eugenia
AU - Beyar, Rafael
AU - Roguin, Ariel
PY - 2013/11
Y1 - 2013/11
N2 - Background: The current revascularization treatment recommendation is different according to lesion location and a higher recommendation is given to surgery for proximal LAD (pLAD) lesions over PCI. This is based on previous studies and expert opinion. We aimed to investigate whether indeed there is a difference in outcome with respect to LAD lesion location while using a drug eluting stent (DES). Methods: The NOBORI-2 trial, enrolled 3067 consecutive patients in 125 centers who were treated with DES for single and multivessel disease. We compared 834 [27.2%] patients who underwent PCI of the pLAD as part of their revascularization, to 2203 [71.8%] patients in which stenting to other lesion(s) but not the pLAD was performed. Results: The pLAD group had lower incidence of hypertension, peripheral vascular disease, prior PCI and CABG, but had more lesions treated [1.55 ± 0.8 vs. 1.35 ± 0.6], more stents implanted [1.98 ± 1.2 vs. 1.66 ± 1.0] and longer overall stent length [31.8 ± 20.2 vs. 28.2 ± 17.8. mm].There was no difference in the occurrence of the primary endpoint [cardiac death, myocardial infarction and target lesion revascularization] at 1 or 2. years of follow up between the pLAD and non pLAD [6.0% vs. 4.6%, p = 0.14 and 7.7% vs. 6.6%; p = 0.22, respectively]. The relief from anginal symptoms was similar. Multivariate analysis showed that pLAD location was not a variable that predicted MACE or TLF. Stent thrombosis rate was similar. Conclusion: When considering PCI with DES, there is no difference in outcome between patients with and without proximal LAD lesions.
AB - Background: The current revascularization treatment recommendation is different according to lesion location and a higher recommendation is given to surgery for proximal LAD (pLAD) lesions over PCI. This is based on previous studies and expert opinion. We aimed to investigate whether indeed there is a difference in outcome with respect to LAD lesion location while using a drug eluting stent (DES). Methods: The NOBORI-2 trial, enrolled 3067 consecutive patients in 125 centers who were treated with DES for single and multivessel disease. We compared 834 [27.2%] patients who underwent PCI of the pLAD as part of their revascularization, to 2203 [71.8%] patients in which stenting to other lesion(s) but not the pLAD was performed. Results: The pLAD group had lower incidence of hypertension, peripheral vascular disease, prior PCI and CABG, but had more lesions treated [1.55 ± 0.8 vs. 1.35 ± 0.6], more stents implanted [1.98 ± 1.2 vs. 1.66 ± 1.0] and longer overall stent length [31.8 ± 20.2 vs. 28.2 ± 17.8. mm].There was no difference in the occurrence of the primary endpoint [cardiac death, myocardial infarction and target lesion revascularization] at 1 or 2. years of follow up between the pLAD and non pLAD [6.0% vs. 4.6%, p = 0.14 and 7.7% vs. 6.6%; p = 0.22, respectively]. The relief from anginal symptoms was similar. Multivariate analysis showed that pLAD location was not a variable that predicted MACE or TLF. Stent thrombosis rate was similar. Conclusion: When considering PCI with DES, there is no difference in outcome between patients with and without proximal LAD lesions.
KW - Coronary disease
KW - Guidelines
KW - Outcome
KW - Stents
UR - http://www.scopus.com/inward/record.url?scp=84888202883&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84888202883&partnerID=8YFLogxK
U2 - 10.1016/j.carrev.2013.08.003
DO - 10.1016/j.carrev.2013.08.003
M3 - Article
C2 - 24070549
AN - SCOPUS:84888202883
SN - 1553-8389
VL - 14
SP - 325
EP - 332
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
IS - 6
ER -