Proximal left anterior descending coronary artery revascularization with drug-eluting stents
Jorge Humberto Guardado1, Raúl Moreno, João Costa
1Hospital Clinico San Carlos, Madrid, Spain.
Insights
Drug-eluting stents in the proximal left anterior descending artery show excellent outcomes for coronary artery disease patients. This safe and efficient strategy results in high survival rates and low restenosis over the long term.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
- Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a primary revascularization strategy.
- The proximal left anterior descending (LAD) artery is a critical territory for PCI due to its high clinical significance.
Purpose of the Study:
- To evaluate the clinical prognosis of patients with CAD undergoing PCI.
- To assess the efficacy and safety of DES implantation in the proximal LAD.
- To analyze short-term and long-term outcomes, including major adverse cardiac events (MACE).
Main Methods:
- A cohort of 170 consecutive patients with CAD received at least one DES in the proximal LAD.
- Stents used included sirolimus-eluting (CYPHER) and paclitaxel-eluting (TAXUS) devices.
- Clinical follow-up averaged 11 months, with angiographic assessment at 6-9 months. Endpoints included death, myocardial infarction, and reintervention.
Main Results:
- Immediate angiographic success was achieved in all patients.
- In-hospital MACE included 2 deaths and 2 myocardial infarctions; 2 revascularizations for stent thrombosis.
- At 6 months, 1 additional death and 3 MIs occurred. Overall survival free from MACE was 91%, with 3% cardiac mortality and 4.1% binary restenosis in the proximal LAD. Target vessel revascularization-free survival was 94%.
Conclusions:
- PCI with DES in the proximal LAD is a safe and highly effective treatment.
- The strategy demonstrates favorable short-term and long-term clinical outcomes.
- Low rates of restenosis and stent thrombosis support its use in this critical coronary segment.
Objective:
To assess the clinical prognosis of patients with coronary artery diseases undergoing percutaneous revascularization with drug-eluting stent implantation in the proximal left anterior descending coronary artery.
Methods:
One hundred and seventy consecutive patients with mean age of 65 years, 49 of them females (29%), undergoing implantation of at least one drug-eluting stent in our medical center. The total number of drug-eluting stents implanted was 189, of which 115 (61%) were sirolimus-eluting (CYPHER) and 74 (39%) were paclitaxel-eluting stents (TAXUS). In 100 (60%) of the cases, multivessel coronary artery disease was present. In 61 (36%) patients another coronary artery segment was treated in addition to the proximal left anterior descending coronary artery. The mean clinical follow-up period was 11 +/- 5 months, and angiographic controls were performed between 6 and 9 months. The final endpoint was a composite of death, acute myocardial infarction and need for reintervention on the anterior descending. The secondary endpoint included the occurrence of restenosis, need for reintervention on the proximal segment of the left anterior descending and stent thrombosis.
Results:
The procedure achieved immediate angiographic success in all patients. Two deaths, two acute myocardial infarctions, and two percutaneous coronary reinterventions due to stent thrombosis were recorded during in-hospital stay. At the sixth month of follow-up, an additional cardiac death and three myocardial infarctions were observed; three repeat revascularization procedures were required. Up to the end of the follow-up, three additional deaths, three myocardial infarctions and eight revascularization procedures of the anterior descending, two of them surgical, were verified. Survival free from major adverse cardiac events was 91%. Cardiac mortality was 3%. Binary restenosis in the proximal segment of the left anterior descending coronary artery was 4.1%. Target vessel revascularization-free survival was 94%. No cases of late stent thrombosis were observed.
Conclusion:
Percutaneous revascularization of the proximal left anterior descending coronary artery with implantation of drug-eluting stents is a safe and very efficient therapeutic strategy in the short and long terms.
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