所属 医学部 医学科（東京女子医科大学病院） 職種 講師
|発表タイトル||Long Term Prognoses of Patients With and Without Left Anterior Descending Coronary Artery Stenosis in the DES Era|
|会議名||AHA2016 (American Heart Associations Scientific Sessions 2016)|
|主催者||American Heart Associations|
|発表者・共同発表者||◎SHIMAZAKI Kensuke, JUJO Kentaro, MINAMI Yuichiro, HARUKI Shintaro, ITANI Ryosuke, OOTSUKI Hisao, NAKAO Masashi, YAMAGUCHI Junichi, OGAWA Hiroshi, HAGIWARA Nobuhisa|
|New Orleans, USA|
Background: Atherosclerosis in patients with coronary artery disease (CAD) generally starts at the proximal sit of left anterior descending (LAD) artery. However, CAD without LAD was frequently identified in daily coronary angiogram, and the relationship between localization of CAD and long-term prognosis in the drug-eluting stent era has not been fully elucidated.
Methods: Of 2497 consecutive CAD patients who underwent percutaneous coronary intervention (PCI) between 2010 and 2015, 1245 patients of the first-time PCI in their lives were enroll in this study. Baseline profiles and long-term prognoses including all-cause death and major adverse cardiac event (MACE) were compared in de novo CAD patients with LAD (n=986, 79%) and Non-LAD (n=259, 21%). Moreover their prognoses was compared with patients who received coronary artery bypass grafting (CABG, n=175) at the same registration period as PCI. MACE included cardiovascular death, non-fatal myocardial infarction and target vascular revascularization.
Results: LAD group consisted of older patients with higher prevalence of diabetes and dyslipidemia, and also with impaired cardiac and renal function, compared to Non-LAD group. Angiography showed that LAD group had significantly more multi-vessel disease, calcified lesion and long lesion than Non-LAD group. Kaplan-Meier analysis with 514 days of median follow-up showed that all-cause death an MACE were both significantly higher in LAD group (3-year MACE: 24.6% vs. 7.1%). LAD group included 11% of le main trunk lesion; however the presence of left main trunk lesion did not significantly affect on long-term prognosis in LAD group (Figure). As compared to patients with CABG, Non-LAD group showed similar prognoses while, LAD group were significantly worse in both all-cause death and MACE.
Conclusions: Patients with LAD stenosis have severer atherosclerotic profiles, and the presence of stenosis in LAD is associated with poor long term prognoses