Patients with coronary artery disease (CAD) typically develop atherosclerosis proximal to the left anterior descending coronary artery (LAD). However, it is unclear how CAD location affects long-term prognosis in the era of drug-eluting stents. This study compared the clinical profiles and long-term outcomes of patients with and without LAD lesions after percutaneous coronary intervention (PCI). Of 2,497 consecutive patients with CAD who underwent PCI, 1,245 who underwent first-time PCI were enrolled. Baseline profiles and long-term prognoses, including major adverse cardiovascular events (MACE), were compared between patients with de novo CAD localized to the LAD (n=986) and non-LAD lesions (n=259). MACE included cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization. Patients in the LAD group were more likely to be older; had an increased prevalence of diabetes, dyslipidemia, and impaired cardiac and renal function; and had significantly more multi-vessel disease, calcified lesions, and long lesions than the non-LAD group. Kaplan-Meier analysis revealed that the MACE rate was significantly higher in the LAD group (16.6% vs. 5.4%, p<0.001) regardless of the presence of the left main disease. LAD lesions were associated with an increased rate of MACE independent of other prognostic factors (hazard ratio: 2.26, 95% confidence interval: 1.19-4.28). Patients with LAD lesions had worse atherosclerotic profiles at baseline; this was associated with a poorer prognosis after the initial PCI. These findings indicate the importance of early detection and management of LAD lesions in improving the long-term prognosis of patients with CAD.
Tanaka et al. (Tue,) studied this question.