Ostial vs proximal stenting in LAD stenosis: A comparative study

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Proximal left anterior descending (LAD) artery disease is linked to poor clinical outcomes.
• Ostial proximal LAD (O-pLAD) lesions pose technical challenges in percutaneous coronary intervention (PCI).
• Limited data exist comparing PCI outcomes for O-pLAD versus non-ostial proximal LAD (NO-pLAD) lesions.

Purpose of the Study:

• To compare 2-year clinical outcomes of PCI for O-pLAD versus NO-pLAD lesions.
• To evaluate the impact of lesion location on PCI success and patient prognosis.
• To inform revascularization strategy selection for proximal LAD disease.

Main Methods:

• Single-center retrospective cohort study (June 2017-September 2023).
• Inclusion of patients undergoing PCI for significant proximal LAD lesions.
• Definition of O-pLAD (stenosis within 5 mm of ostium) and NO-pLAD lesions.
• Primary endpoint: target lesion failure (TLF) at 2-year follow-up.
• Multivariable Cox regression and inverse probability of treatment weighting (IPTW) for analysis.

Main Results:

• 1229 patients included (522 O-pLAD, 707 NO-pLAD).
• O-pLAD patients were older with more multivessel disease and calcification.
• Higher TLF rates in O-pLAD group (14.6%) vs. NO-pLAD group (7.9%) at 2 years.
• NO-pLAD lesions showed significantly lower TLF and target lesion revascularization (TLR) after IPTW analysis.
• No significant differences in cardiac death, target-vessel MI, or major adverse cardiovascular events.

Conclusions:

• PCI for NO-pLAD lesions is associated with significantly lower 2-year TLF and TLR rates compared to O-pLAD lesions.
• Ostial involvement in proximal LAD disease is a critical factor influencing PCI outcomes.
• Findings emphasize the importance of considering lesion location when planning revascularization strategies for proximal LAD disease.