Long-term mortality following percutaneous coronary intervention to the proximal left anterior descending artery: a multi-centre Australian Registry Review.

Abstract

Background: The left anterior descending (LAD) artery supplies a large area of myocardium, and significant proximal segment stenosis leads to widespread ischaemia. In stable coronary artery disease (CAD), strong recommendations exist for proximal LAD (pLAD) revascularisation to improve prognosis. This study aimed to compare early and long-term mortality after pLAD percutaneous coronary intervention (PCI) with non-pLAD PCI in patients with stable CAD.

Method: Consecutive patients with stable angina who underwent PCI from the Melbourne Interventional Group (MIG) registry between 2005 and 2017 were included, with analysis stratified to pLAD and non-pLAD PCI. National Death Index (NDI) linkage was used to determine 5-year mortality rates and for Cox proportional hazards modelling.

Results: A total of 7,642 procedures were captured (1,116 pLAD and 6,526 non-pLAD). There was no difference in the long-term mortality between pLAD PCI and non-pLAD PCI (see graph). Proximal LAD PCI was not an independent predictor of long-term mortality (HR 1.34, 95% CI 0.97–1.86, p = 0.08).

Conclusion: In this large multi-centre registry, early and long-term mortality after pLAD PCI in stable CAD were comparable with non-pLAD PCI. This suggests that in the setting of stable CAD, lesion location alone should not affect the decision to offer PCI.