Impact of Proximal LAD Lesions on Long-term PCI Outcomes in Pakistani Patients

Abstract

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.