Should Proximal LAD be treated differently? Insights from a large DES stent registry

Arthur Kerner, Eitan Abergel, Majdi Halabi, Amit Soni, Gian Battista Danzi, Sergey Yalonestky, Erik Spaepen, Dragica Paunovic, Eugenia Nikolsky, Rafael Beyar, Ariel Roguin

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: The current revascularization treatment recommendation is different according to lesion location and a higher recommendation is given to surgery for proximal LAD (pLAD) lesions over PCI. This is based on previous studies and expert opinion. We aimed to investigate whether indeed there is a difference in outcome with respect to LAD lesion location while using a drug eluting stent (DES). Methods: The NOBORI-2 trial, enrolled 3067 consecutive patients in 125 centers who were treated with DES for single and multivessel disease. We compared 834 [27.2%] patients who underwent PCI of the pLAD as part of their revascularization, to 2203 [71.8%] patients in which stenting to other lesion(s) but not the pLAD was performed. Results: The pLAD group had lower incidence of hypertension, peripheral vascular disease, prior PCI and CABG, but had more lesions treated [1.55 ± 0.8 vs. 1.35 ± 0.6], more stents implanted [1.98 ± 1.2 vs. 1.66 ± 1.0] and longer overall stent length [31.8 ± 20.2 vs. 28.2 ± 17.8. mm].There was no difference in the occurrence of the primary endpoint [cardiac death, myocardial infarction and target lesion revascularization] at 1 or 2. years of follow up between the pLAD and non pLAD [6.0% vs. 4.6%, p = 0.14 and 7.7% vs. 6.6%; p = 0.22, respectively]. The relief from anginal symptoms was similar. Multivariate analysis showed that pLAD location was not a variable that predicted MACE or TLF. Stent thrombosis rate was similar. Conclusion: When considering PCI with DES, there is no difference in outcome between patients with and without proximal LAD lesions.

Original languageEnglish
Pages (from-to)325-332
Number of pages8
JournalCardiovascular Revascularization Medicine
Issue number6
StatePublished - Nov 2013
Externally publishedYes

Bibliographical note

Funding Information:
Conflicts of interest and funding: Drs. Danzi and Roguin received Research Support grants from Terumo . Dr. Dragica Paunovic is employed by Terumo Europe. None of the other authors has any disclosure or any relationships that could be viewed as presenting a potential conflict of interest for the current study.


  • Coronary disease
  • Guidelines
  • Outcome
  • Stents


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