Should Proximal LAD be treated differently? Insights from a large DES stent registry

Arthur Kerner, Eitan Abergel, Majdi Halabi, Amit Soni, Gian Battista Danzi, Sergey Yalonestky, Erik Spaepen, Dragica Paunovic, Eugenia Nikolsky, Rafael Beyar, Ariel Roguin

Research output: Contribution to journalArticle

Abstract

Background: The current revascularization treatment recommendation is different according to lesion location and a higher recommendation is given to surgery for proximal LAD (pLAD) lesions over PCI. This is based on previous studies and expert opinion. We aimed to investigate whether indeed there is a difference in outcome with respect to LAD lesion location while using a drug eluting stent (DES). Methods: The NOBORI-2 trial, enrolled 3067 consecutive patients in 125 centers who were treated with DES for single and multivessel disease. We compared 834 [27.2%] patients who underwent PCI of the pLAD as part of their revascularization, to 2203 [71.8%] patients in which stenting to other lesion(s) but not the pLAD was performed. Results: The pLAD group had lower incidence of hypertension, peripheral vascular disease, prior PCI and CABG, but had more lesions treated [1.55 ± 0.8 vs. 1.35 ± 0.6], more stents implanted [1.98 ± 1.2 vs. 1.66 ± 1.0] and longer overall stent length [31.8 ± 20.2 vs. 28.2 ± 17.8. mm].There was no difference in the occurrence of the primary endpoint [cardiac death, myocardial infarction and target lesion revascularization] at 1 or 2. years of follow up between the pLAD and non pLAD [6.0% vs. 4.6%, p = 0.14 and 7.7% vs. 6.6%; p = 0.22, respectively]. The relief from anginal symptoms was similar. Multivariate analysis showed that pLAD location was not a variable that predicted MACE or TLF. Stent thrombosis rate was similar. Conclusion: When considering PCI with DES, there is no difference in outcome between patients with and without proximal LAD lesions.

Original languageEnglish (US)
Pages (from-to)325-332
Number of pages8
JournalCardiovascular Revascularization Medicine
Volume14
Issue number6
DOIs
StatePublished - Nov 2013
Externally publishedYes

Fingerprint

Drug-Eluting Stents
Stents
Registries
Peripheral Vascular Diseases
Expert Testimony
Thrombosis
Multivariate Analysis
Myocardial Infarction
Hypertension
Incidence
Therapeutics

Keywords

  • Coronary disease
  • Guidelines
  • Outcome
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kerner, A., Abergel, E., Halabi, M., Soni, A., Danzi, G. B., Yalonestky, S., ... Roguin, A. (2013). Should Proximal LAD be treated differently? Insights from a large DES stent registry. Cardiovascular Revascularization Medicine, 14(6), 325-332. https://doi.org/10.1016/j.carrev.2013.08.003

Should Proximal LAD be treated differently? Insights from a large DES stent registry. / Kerner, Arthur; Abergel, Eitan; Halabi, Majdi; Soni, Amit; Danzi, Gian Battista; Yalonestky, Sergey; Spaepen, Erik; Paunovic, Dragica; Nikolsky, Eugenia; Beyar, Rafael; Roguin, Ariel.

In: Cardiovascular Revascularization Medicine, Vol. 14, No. 6, 11.2013, p. 325-332.

Research output: Contribution to journalArticle

Kerner, A, Abergel, E, Halabi, M, Soni, A, Danzi, GB, Yalonestky, S, Spaepen, E, Paunovic, D, Nikolsky, E, Beyar, R & Roguin, A 2013, 'Should Proximal LAD be treated differently? Insights from a large DES stent registry', Cardiovascular Revascularization Medicine, vol. 14, no. 6, pp. 325-332. https://doi.org/10.1016/j.carrev.2013.08.003
Kerner, Arthur ; Abergel, Eitan ; Halabi, Majdi ; Soni, Amit ; Danzi, Gian Battista ; Yalonestky, Sergey ; Spaepen, Erik ; Paunovic, Dragica ; Nikolsky, Eugenia ; Beyar, Rafael ; Roguin, Ariel. / Should Proximal LAD be treated differently? Insights from a large DES stent registry. In: Cardiovascular Revascularization Medicine. 2013 ; Vol. 14, No. 6. pp. 325-332.
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abstract = "Background: The current revascularization treatment recommendation is different according to lesion location and a higher recommendation is given to surgery for proximal LAD (pLAD) lesions over PCI. This is based on previous studies and expert opinion. We aimed to investigate whether indeed there is a difference in outcome with respect to LAD lesion location while using a drug eluting stent (DES). Methods: The NOBORI-2 trial, enrolled 3067 consecutive patients in 125 centers who were treated with DES for single and multivessel disease. We compared 834 [27.2{\%}] patients who underwent PCI of the pLAD as part of their revascularization, to 2203 [71.8{\%}] patients in which stenting to other lesion(s) but not the pLAD was performed. Results: The pLAD group had lower incidence of hypertension, peripheral vascular disease, prior PCI and CABG, but had more lesions treated [1.55 ± 0.8 vs. 1.35 ± 0.6], more stents implanted [1.98 ± 1.2 vs. 1.66 ± 1.0] and longer overall stent length [31.8 ± 20.2 vs. 28.2 ± 17.8. mm].There was no difference in the occurrence of the primary endpoint [cardiac death, myocardial infarction and target lesion revascularization] at 1 or 2. years of follow up between the pLAD and non pLAD [6.0{\%} vs. 4.6{\%}, p = 0.14 and 7.7{\%} vs. 6.6{\%}; p = 0.22, respectively]. The relief from anginal symptoms was similar. Multivariate analysis showed that pLAD location was not a variable that predicted MACE or TLF. Stent thrombosis rate was similar. Conclusion: When considering PCI with DES, there is no difference in outcome between patients with and without proximal LAD lesions.",
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AU - Kerner, Arthur

AU - Abergel, Eitan

AU - Halabi, Majdi

AU - Soni, Amit

AU - Danzi, Gian Battista

AU - Yalonestky, Sergey

AU - Spaepen, Erik

AU - Paunovic, Dragica

AU - Nikolsky, Eugenia

AU - Beyar, Rafael

AU - Roguin, Ariel

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N2 - Background: The current revascularization treatment recommendation is different according to lesion location and a higher recommendation is given to surgery for proximal LAD (pLAD) lesions over PCI. This is based on previous studies and expert opinion. We aimed to investigate whether indeed there is a difference in outcome with respect to LAD lesion location while using a drug eluting stent (DES). Methods: The NOBORI-2 trial, enrolled 3067 consecutive patients in 125 centers who were treated with DES for single and multivessel disease. We compared 834 [27.2%] patients who underwent PCI of the pLAD as part of their revascularization, to 2203 [71.8%] patients in which stenting to other lesion(s) but not the pLAD was performed. Results: The pLAD group had lower incidence of hypertension, peripheral vascular disease, prior PCI and CABG, but had more lesions treated [1.55 ± 0.8 vs. 1.35 ± 0.6], more stents implanted [1.98 ± 1.2 vs. 1.66 ± 1.0] and longer overall stent length [31.8 ± 20.2 vs. 28.2 ± 17.8. mm].There was no difference in the occurrence of the primary endpoint [cardiac death, myocardial infarction and target lesion revascularization] at 1 or 2. years of follow up between the pLAD and non pLAD [6.0% vs. 4.6%, p = 0.14 and 7.7% vs. 6.6%; p = 0.22, respectively]. The relief from anginal symptoms was similar. Multivariate analysis showed that pLAD location was not a variable that predicted MACE or TLF. Stent thrombosis rate was similar. Conclusion: When considering PCI with DES, there is no difference in outcome between patients with and without proximal LAD lesions.

AB - Background: The current revascularization treatment recommendation is different according to lesion location and a higher recommendation is given to surgery for proximal LAD (pLAD) lesions over PCI. This is based on previous studies and expert opinion. We aimed to investigate whether indeed there is a difference in outcome with respect to LAD lesion location while using a drug eluting stent (DES). Methods: The NOBORI-2 trial, enrolled 3067 consecutive patients in 125 centers who were treated with DES for single and multivessel disease. We compared 834 [27.2%] patients who underwent PCI of the pLAD as part of their revascularization, to 2203 [71.8%] patients in which stenting to other lesion(s) but not the pLAD was performed. Results: The pLAD group had lower incidence of hypertension, peripheral vascular disease, prior PCI and CABG, but had more lesions treated [1.55 ± 0.8 vs. 1.35 ± 0.6], more stents implanted [1.98 ± 1.2 vs. 1.66 ± 1.0] and longer overall stent length [31.8 ± 20.2 vs. 28.2 ± 17.8. mm].There was no difference in the occurrence of the primary endpoint [cardiac death, myocardial infarction and target lesion revascularization] at 1 or 2. years of follow up between the pLAD and non pLAD [6.0% vs. 4.6%, p = 0.14 and 7.7% vs. 6.6%; p = 0.22, respectively]. The relief from anginal symptoms was similar. Multivariate analysis showed that pLAD location was not a variable that predicted MACE or TLF. Stent thrombosis rate was similar. Conclusion: When considering PCI with DES, there is no difference in outcome between patients with and without proximal LAD lesions.

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