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<p>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.&#xa0;This study compared the clinical profiles and long-term outcomes of patients with and without LAD lesions after percutaneous coronary intervention (PCI).&#xa0;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.&#xa0;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&lt;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).&#xa0;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.</p> Graphical Abstract <p>Prognostic comparisons of in-hospital mortality and MACE after PCI in patients with and without LAD lesions.&#xa0;Comparison of in-hospital mortality and MACE between patients with and without LAD lesions.&#xa0;LAD, left anterior descending artery; MACE, major adverse cardiovascular event; PCI, percutaneous coronary intervention.</p> <p></p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月3日

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  • Eiji Shibahashi,
  • Kensuke Shimazaki,
  • Yusuke Inagaki,
  • Takehiro Hata,
  • Shintaro Haruki,
  • Hisao Otsuki,
  • Junichi Yamaguchi,
  • Kentaro Jujo

摘要

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.

Graphical Abstract

Prognostic comparisons of in-hospital mortality and MACE after PCI in patients with and without LAD lesions. Comparison of in-hospital mortality and MACE between patients with and without LAD lesions. LAD, left anterior descending artery; MACE, major adverse cardiovascular event; PCI, percutaneous coronary intervention.