Prognostic significance of severe narrowing of the proximal portion of the left anterior descending coronary artery

Klein, Lloyd W.; Weintraub, William S.; Agarwal, Jai B.; Schneider, R; Seelaus, Paul A.; Katz, Robert I.; Helfant, Richard H.

doi:10.1016/0002-9149(86)90238-9

Cited by 136 publications

(53 citation statements)

References 9 publications

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“…1,2 Minimally invasive direct coronary artery bypass surgery and percutaneous coronary intervention with bare-metal stents are established treatment options that effectively relieve symptoms. 3,4 In randomized trials comparing the 2 strategies, a significantly higher reintervention rate after stenting and similar results for mortality and reinfarction at a 6-month follow-up have been demonstrated.…”

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confidence: 99%

Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

et al. 2005

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Background-Randomized trials comparing stenting with minimally invasive direct coronary artery bypass surgery in patients with isolated proximal left anterior descending lesions have shown a significantly higher reintervention rate for stenting and similar results for mortality and reinfarction at short-term follow-up. Long-term follow-up data are sparse. Methods and Results-Patients with isolated proximal left anterior descending stenosis were randomized to either surgery (nϭ110) or bare-metal stenting (nϭ110). At 5 years, follow-up data were obtained with respect to the primary end point of death, reinfarction, or repeated target vessel revascularization. Clinical symptoms were assessed by the Canadian Cardiovascular Society (CCS) classification. Follow-up information was completed for 216 patients (98.2%), and mean follow-up was 5.6Ϯ1.2 years. With respect to mortality (surgery, 12%; stenting, 10%; Pϭ0.54) and reinfarctions (surgery, 7%; stenting, 5%; Pϭ0.46), there were no differences between treatment strategies. The need for repeated target vessel revascularization was significantly higher after stenting (32%) compared with surgery (10%; PϽ0.001).Clinical symptoms improved significantly in both treatment groups compared with baseline; however, there was a favorable trend for surgery (stenting: CCS, 2.6Ϯ0.9 to 0.5Ϯ0.8, PϽ0.001; surgery: CCS, 2.6Ϯ0.9 to 0.3Ϯ0.6, PϽ0.001; Pϭ0.05, stenting versus surgery). Conclusions-At the 5-year follow-up, minimally invasive bypass surgery and bare-metal stenting showed similar results for the end points of mortality and reinfarctions. However, the reintervention rate is higher after stenting, and the relief in clinical symptoms is slightly better after surgery. (Circulation. 2005;112:3445-3450.)

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Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

et al. 2005

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“…Therefore, a severe obstructive lesion involving its proximal portion is an important predictor of morbidity and mortality 13,14 . In these cases, invasive treatment is usually indicated, particularly when a large myocardial area is under a higher risk [15][16][17] .…”

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confidence: 99%

Percutaneous Stent Implantation for Treating Multivessel Coronary Disease in Patients with and without Involvement of the Proximal Segment of the Anterior Descending Coronary Artery

Salgueiro¹,

Silva²,

Tofano³

et al. 2002

Arq. Bras. Cardiol.

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Objective -To assess coronary stent placement in patients with multivessel coronary disease and involvement of the proximal portion of the anterior descending coronary artery. Methods -We retrospectively analyzed the in-hospitalPatients with multivessel coronary disease who have lesion in the proximal segment of the anterior descending coronary artery have a shorter event-free survival when treated with balloon catheter coronary angioplasty as compared with those who do not have lesion in that arterial segment 1,2 . This fact limited the use of that technique, and the surgical procedure became the preferential option for treating that type of patient 3 .Stents, however, are currently used in more than 70% of the percutaneous coronary procedures and have been shown to provide a great number of benefits, such as the possibility of treating more complex lesions, the control of the complications of coronary dilation, a better clinical evolution, and a significant reduction in restenosis 4,5 . In addition, a substudy of the Stent Restenosis Study 6 , which randomized patients with single-vessel coronary disease for balloon catheter coronary angioplasty or stent placement, showed that the most benefited subgroup in regard to restenosis comprised patients with lesion in the anterior descending coronary artery treated with stents.However, it has not yet been clarified whether in patients with multivessel coronary disease, stent placement may provide similar results in the groups with and without obstruction of the proximal segment of the anterior descending coronary artery. Therefore, in our study, we compared the in-hospital results and the clinical evolution of the patients who had undergone stent implantation.

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“…Historicamente, pacientes uniarteriais com estenose significativa na DA têm apresentado prognóstico cardíaco menos favorável, sobretudo no que tange à maior necessidade de reintervenção na lesão-alvo, quando comparados aos pacientes uniarteriais sem envolvimento dessa artéria [4][5][6] .…”

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Stents farmacológicos versus não-farmacológicos para o tratamento de pacientes uniarteriais portadores de lesão em artéria descendente anterior: seguimento clínico de dois anos

Lasave¹,

Costa²,

Abizaid³

et al. 2008

Rev. Bras. Cardiol. Invasiva

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The primary endpoint was the comparison of major adverse cardiac events (MACE) defined as cardiac death, non fatal MI and target-lesion revascularization (TLR) between the two groups. Results: Baseline clinical characteristics did not differ between groups. Procedure success was achieved in all cases with no in hospital MACE. After two years of follow-up, 95.7% of patients treated with DES and 73.7% treated with BMS were free from any MACE (p < 0.0001). TLR occurred in 15.6% and 1.2% of the patients receiving BMS and DES respectively (p < 0.0001). Although not significantly reduced, cardiac death was less frequent among patients treated with these DES (6.38% vs. 1.81%, p = 0.07). Conclusion: The use of DES for the treatment of single LAD lesions was superior to BMS due to a marked reduction in MACE rates, mainly at the expense of a very low need for RLA.

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Prognostic significance of severe narrowing of the proximal portion of the left anterior descending coronary artery

Cited by 136 publications

References 9 publications

Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery

Percutaneous Stent Implantation for Treating Multivessel Coronary Disease in Patients with and without Involvement of the Proximal Segment of the Anterior Descending Coronary Artery

Stents farmacológicos versus não-farmacológicos para o tratamento de pacientes uniarteriais portadores de lesão em artéria descendente anterior: seguimento clínico de dois anos

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