Leborgne Laurent, Cheneau Edouard, Wolfram Roswitha, Ajani Andrew, Pakala Rajbabu, Canos Daniel, Pinnow Ellen, Pichard Augusto D, Satler Lowell F, Waksman Ron
Division of Cardiology, Cardiovascular Research Institute, Washington Hospital Center, Suite 4B-1, 110 Irving Street, NW, Washington, DC 20100, USA.
Cardiovasc Radiat Med. 2002 Jul-Dec;3(3-4):127-32. doi: 10.1016/s1522-1865(03)00095-7.
Patients treated for lesions in the proximal left anterior descending coronary artery (P-LAD) have worse outcome after balloon angioplasty as compared to patients treated for lesions in the distal left anterior descending coronary artery (D-LAD). We sought to examine if this discrepancy was still observed after stenting.
A total of 676 consecutive patients with a symptomatic monovessel disease in the LAD artery who underwent angioplasty with stenting were prospectively entered into a dedicated database. Among this cohort, 322 lesions were located in P-LAD and 354 in D-LAD. Patients with total occlusion, acute myocardial infarction (MI) or restenosis were excluded.
Procedural characteristics were similar in the two groups. Procedural success was high with the same rates of in-hospital death and Q-wave MI for patients treated in P-LAD and D-LAD. At 1 year, the rate of target lesion revascularization (TLR) was 13.9% in the P-LAD group and 16.3% in the D-LAD group (P = .79), and the rate of event-free survival was 81.9% and 81% (P = .67), respectively. The treatment of ostial lesions (n = 23) was not related to worse outcome. In multivariate analysis, lesion location was not a predictor of major adverse cardiac events (MACE).
This study shows that stenting of lesions in the P-LAD is as effective and safe as treatment of lesions located in D-LAD. Therefore, when stenting is feasible, the location of the lesion in the LAD is not predictive of worse outcome and, consequently, should not be taken into account in the choice of the revascularization strategy.
与接受左前降支冠状动脉远端（D-LAD）病变治疗的患者相比，接受左前降支冠状动脉近端（P-LAD）病变治疗的患者在球囊血管成形术后预后更差。我们试图研究在置入支架后是否仍存在这种差异。
共有676例有症状的单支LAD动脉疾病患者接受了支架血管成形术，并被前瞻性纳入一个专门的数据库。在这个队列中，322处病变位于P-LAD，354处病变位于D-LAD。排除完全闭塞、急性心肌梗死（MI）或再狭窄患者。
两组的手术特征相似。手术成功率高，P-LAD和D-LAD治疗的患者住院死亡率和Q波MI发生率相同。1年时，P-LAD组的靶病变血管重建率（TLR）为13.9%，D-LAD组为16.3%（P = 0.79），无事件生存率分别为81.9%和81%（P = 0.67）。开口处病变（n = 23）的治疗与较差的预后无关。在多变量分析中，病变位置不是主要不良心脏事件（MACE）的预测因素。
本研究表明，P-LAD病变的支架置入与D-LAD病变的治疗一样有效和安全。因此，当可行支架置入时，LAD病变的位置不能预测较差的预后，因此，在选择血运重建策略时不应考虑该因素。
