Impact of Proximal LAD Lesions on Long-term PCI Outcomes in Pakistani Patients
DOI:
https://doi.org/10.61919/jhrr.v4i3.1292Keywords:
: Percutaneous Coronary Intervention, Proximal LAD Lesions, Coronary Artery DiseaseAbstract
Background: The left anterior descending (LAD) artery is a critical vessel supplying a significant portion of the heart muscle. Lesions in the proximal LAD are associated with extensive myocardial infarctions and adverse cardiovascular events. Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has become the standard treatment for LAD lesions, offering improved patency rates and reduced restenosis.
Objective: This study aimed to evaluate the long-term outcomes of PCI in Pakistani patients with proximal LAD lesions, focusing on the incidence of major adverse cardiac events (MACE) over a 12-month follow-up period.
Methods: This prospective observational study was conducted at Lady Reading Hospital, Peshawar, from January 2022 to December 2023. The study included 250 adult patients diagnosed with significant proximal LAD stenosis and undergoing PCI. Patients with chronic kidney disease (stage 4 or higher), severe left ventricular dysfunction (ejection fraction <30%), and those unable to provide informed consent were excluded. PCI procedures were performed using DES, and patients received dual antiplatelet therapy (DAPT) for at least 12 months post-PCI. Data were collected during hospital stays and follow-up visits at 1, 6, and 12 months post-PCI. The primary outcome was MACE, including all-cause mortality, myocardial infarction (MI), and target vessel revascularization (TVR). Secondary outcomes included stent thrombosis, bleeding complications, and quality of life assessed using the EQ-5D questionnaire. Data analysis was performed using SPSS version 25.0, with Kaplan-Meier survival curves and Cox proportional hazards regression analysis.
Results: The study found that 10% of patients experienced MACE, including 4% all-cause mortality, 3.2% MI, and 2.8% TVR. Stent thrombosis occurred in 2% of patients, and bleeding complications were reported in 4.8%. Quality of life improved significantly, with the EQ-5D index increasing from 0.68 ± 0.15 at baseline to 0.82 ± 0.13 at the 12-month follow-up (p < 0.001). Age and history of previous MI were identified as independent predictors of MACE.
Conclusion: PCI with DES significantly improves long-term outcomes and quality of life in Pakistani patients with proximal LAD lesions. These findings underscore the need for advanced interventional techniques and vigilant post-PCI monitoring to enhance patient outcomes.
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References
Kandzari DE, Colombo A, Park SJ, et al. Revascularization for Unprotected Left Main Disease: Evolution of the Evidence Basis to Redefine Treatment Standards. J Am Coll Cardiol. 2016;68(12):1230-43.
Yusuf S, Reddy S, Ounpuu S, Anand S. Global Burden of Cardiovascular Diseases: Part I: General Considerations, the Epidemiologic Transition, Risk Factors, and Impact of Urbanization. Circulation. 2001;104(22):2746-53.
Jafar TH, Jafary FH, Jessani S, Chaturvedi N. Heart Disease Epidemic in Pakistan: Women and Men at Equal Risk. Am Heart J. 2005;150(2):221-26.
Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics—2015 Update: A Report From the American Heart Association. Circulation. 2015;131(4).
Stone GW, Sabik JF, Serruys PW, et al. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med. 2016;375(23):2223-35.
Giustino G, Chieffo A, Palmerini T, et al. Efficacy and Safety of Dual Antiplatelet Therapy After Complex PCI. J Am Coll Cardiol. 2016;68(17):1851-64.
Dangas GD, Serruys PW, Kereiakes DJ, et al. Meta-Analysis of Everolimus-Eluting Stents Versus Bare-Metal Stents in Coronary Artery Disease: Final Results From the SORT OUT IV, SORT OUT V, and SORT OUT VI Trials. J Am Coll Cardiol. 2014;64(23):2563-69.
Byrne RA, Stone GW, Ormiston JA, et al. Coronary Stent Thrombosis: New Insights Into Mechanisms and Prevention. Circ Cardiovasc Interv. 2017;10(3).
Kandzari DE, Colombo A, Park SJ, et al. Revascularization for Unprotected Left Main Disease: Evolution of the Evidence Basis to Redefine Treatment Standards. J Am Coll Cardiol. 2016;68(12):1230-43.
Stone GW, Sabik JF, Serruys PW, et al. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med. 2016;375(23):2223-35.
Giustino G, Chieffo A, Palmerini T, et al. Efficacy and Safety of Dual Antiplatelet Therapy After Complex PCI. J Am Coll Cardiol. 2016;68(17):1851-64.
Cohen DJ, Van Hout B, Serruys PW, et al. Quality of Life After PCI With Drug-Eluting Stents or Coronary-Artery Bypass Surgery. N Engl J Med. 2011;364(11):1016-26.
Mehran R, Baber U, Steg PG, et al. Cessation of Dual Antiplatelet Treatment and Cardiac Events After Percutaneous Coronary Intervention: An Observational Analysis From the PARIS Registry. Lancet. 2013;382(9906):1714-22.
Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics—2015 Update: A Report From the American Heart Association. Circulation. 2015;131(4).
Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2016;68(10):1082-115.
Cutlip DE, Windecker S, Mehran R, et al. Clinical End Points in Coronary Stent Trials: A Case for Standardized Definitions. Circulation. 2007;115(17):2344-51.
Stefanini GG, Holmes DR Jr. Drug-Eluting Coronary-Artery Stents. N Engl J Med. 2013;368(3):254-65.
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