Prognostic stratification of patients with coronary artery stenosis by presence or absence of left anterior descending artery lesions

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.