Ten-year survival after stenting the proximal left anterior descending coronary artery with new-generation drug-eluting stents

Percutaneous coronary intervention (PCI) of the proximal left anterior descending artery (p-LAD) is often considered a high-risk procedure, as the LAD supplies a substantial proportion of the myocardium. For most chronic coronary syndrome (CCS) patients with p-LAD target lesions, guidelines do not favor PCI over CABG, or vice versa. Long-term clinical data is lacking in new-generation drug-eluting stents (DES) used in p-LAD lesions. Therefore, we aimed to assess 10-year survival following PCI of the p-LAD versus other segments. We assessed patient-level data of consecutive all-comers, treated at Thoraxcentrum Twente with new-generation DES in the TWENTE I-III trials. Previous CABG or left main treatment were excluded. The primary endpoint was 10-year survival. Additionally, 5-year clinical events were assessed, including composite endpoints target lesion failure (TLF) and patient-oriented composite endpoint (POCE). Of all 4,467 patients, 1,244(27.8%) were treated for p-LAD lesions, while 3,223(72.2%) were treated exclusively for non-p-LAD lesions. After 10 years, all-cause mortality showed a numerically higher incidence in the p-LAD group, which was not statistically significant (24.0% vs. 22.3%; adjusted HR:1.05 95%CI 0.91-1.21, p=0.52). Furthermore, similar 5-year TLF and POCE rates were observed for both groups. In CCS patients, subgroup analyses showed no differences in 10-year survival by lesion location. Yet, the p-LAD group showed significantly lower 5-year repeat revascularization rates. P-LAD lesion location may not independently influence 10-year survival after PCI, both in all-comers and CCS patients. Yet, among CCS patients, 5-year repeat revascularization rates were lower in those treated for p-LAD lesions.