Stenting Location May Not Affect LAD Angioplasty Clinical Outcomes

Patients with proximal left anterior descending (LAD) artery stenosis were found to have comparable clinical outcomes when treated with percutaneous coronary intervention (PCI) in the proximal LAD segment or with nonproximal angioplasty, according to a study published in the Journal of the American Heart Association.

In this analysis of the e-Ultimaster drug-eluting stent system registry, the clinical outcomes of patients treated with angioplasty at proximal (n=5452) vs nonproximal locations (n=12,353) for LAD artery stenosis were compared.

The Ultimaster system is an open-cell, cobalt-chromium, thin-strut (80 μm) sirolimus-eluting stent with an abluminal bioresorbable polymer coating. The system releases sirolimus over a 3- to 4-month period after which the polymer coating fully degrades.

The cohort comprised patients located in Europe, Asia, South America, and Africa. Study participants had coronary artery disease with a reference vessel diameter between 2.5 and 3.5 mm, and were eligible for PCI using the Ultimaster drug-eluting stent. Patients were treated following local hospital practice, and enrolled in the e-Ultimaster registry.

The primary outcome was target lesion failure (TLF), a composite of cardiac death, target vessel-related myocardial infarction (MI), and clinically driven target lesion revascularization at 1-year follow-up. Differences between proximal and nonproximal groups were adjusted using multivariate analysis and propensity scores.

Age and gender were comparable between the 2 groups. A greater percentage of patients receiving nonproximal vs proximal angioplasty smoked, and had hypertension, hypercholesterolemia, previous MI, and previous PCI (P <.001 for all). Patients in the nonproximal vs proximal angioplasty group had lower incidence of multivessel disease (P <.001). After adjusting these variables using propensity analysis, none of the differences were significant.

After propensity weighing, TLF was found to be comparable between the 2 groups at the 3-month (P =.76) and 1-year (P =.17) follow ups. Proximal LAD stenting was not found to be an independent predictor of TLF (odds ratio, 1.07; 95% CI, 0.88-1.31, P =.48).

Study limitations include its observational nature, lack of randomization, and limited follow-up. In addition, a single type of stent was used, patients in the proximal LAD group had worse baseline procedural and lesion characteristics, and data on angiographic follow-up were not collected.

“At 1‐year follow‐up, patients had similar clinical outcomes independent of stenting location, questioning whether proximal LAD treatment should be regarded differently from stenting in any other coronary artery territory,” concluded the study authors.

Reference

Codner P, Saada M, Sakhov O, et al. Proximal left anterior descending artery treatment using a bioresorbable polymer coating sirolimus-eluting stent: real-world outcomes from the multicenter prospective e-Ultimaster registry [published online December 3, 2019]. J Am Heart Assoc. doi: 10.1161/JAHA.119.013786