Coronary artery stenting for isolated proximal left anterior descending stenosis: immediate and follow-up results
Related Experiment Videos
D S Gambhir1, R Sudha, S Singh
1Department of Cardiology, GB Pant Hospital, New Delhi.
Insights
Elective stent implantation for proximal left anterior descending artery stenosis is safe and effective. This coronary artery disease treatment shows high success rates and long-term benefits, reducing major cardiovascular events and revascularization needs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery stenosis, particularly in the proximal left anterior descending (LAD) artery, poses a significant risk for myocardial ischemia and angina.
- Percutaneous coronary intervention with stent implantation has become a primary treatment modality for coronary artery disease.
Purpose of the Study:
- To evaluate the safety and efficacy of elective stent implantation for isolated proximal LAD stenosis.
- To assess in-hospital outcomes and long-term clinical follow-up, including freedom from major adverse cardiovascular events and need for revascularization.
Main Methods:
- A prospective study involving 120 patients with isolated proximal LAD stenosis (≥70% diameter stenosis).
- Elective stent implantation was performed, with successful deployment in all cases.
- Clinical follow-up data were collected for up to 31 months, assessing angina, myocardial infarction, target lesion revascularization (TLR), and death.
Main Results:
- All patients achieved successful stent deployment with no major in-hospital complications (myocardial infarction, emergency bypass surgery, or death).
- Long-term follow-up (mean 18.5 months) showed high rates of freedom from angina (90.8%), myocardial infarction (100%), and death (97.7%).
- Event-free survival was 95.4% at 6 months, decreasing to 82.7% by 31 months. Target lesion revascularization was required in only 4.6% of patients.
Conclusions:
- Elective stenting for isolated proximal LAD stenosis is a safe and highly successful procedure with excellent in-hospital outcomes.
- This interventional strategy offers significant long-term benefits, including a substantial reduction in major cardiovascular events and the need for repeat revascularization.
Abstract:
Between February 1995 to August 1997, 120 patients underwent elective stent implantation for isolated proximal left anterior descending coronary artery stenosis. Their age ranged from 31 to 72 years (mean: 50.8 +/- 10.2) and the majority (89%) were males. All patients had angina, documented myocardial ischemia or both and 70 percent or more luminal diameter stenosis in the proximal left anterior descending before the origin of any branch. Majority (62.5%) of the treated lesions were type A. Successful deployment of the stent at the target site was achieved in all patients without any major in-hospital complications, including myocardial infarction, emergency bypass graft surgery or death. Clinical follow-up, ranging from 6 to 31 months (mean: 18.5 +/- 8.1, median: 20), was available in 87 out of 92 (94.5%) eligible patients who had completed at least six months after the procedure. Freedom from angina, myocardial infarction, target lesion revascularization and death was observed in 90.8, 100, 95.4 and 97.7 percent of patients, respectively. By the Kaplan-Meier estimate, an event-free survival (absence of death, myocardial infarction, recurrence of angina or revascularization) was 95.4 percent at six months, 89.5 percent at 12 and 18 months and 82.7 percent at 24 to 31 months of follow-up. Only 10 (11.5%) patients developed any event and TLR was required in 4.6 percent of patients. In conclusion, elective stenting for isolated proximal left anterior descending stenosis can be achieved safely and successfully in all patients without any adverse in-hospital events. This modality of treatment also provides long-term benefits in terms of reduction in major cardiovascular events and need for subsequent revascularization.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction