PROTECT Evaluates DES Implantation in Left Anterior Descending Artery
March 27, 2017—Ariel Roguin, MD, et al published long-term outcomes of the PROTECT (Patient Related Outcomes with Endeavor Versus Cypher Stenting Trial) trial in the Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2017;10:548–556). PROTECT is a multicenter percutaneous coronary intervention (PCI) trial that enrolled 8,709 patients. The study compared the outcomes of patients undergoing drug-eluting stent (DES) implantation according to lesion location within or outside the proximal left anterior descending (LAD) artery.
As summarized in JACC: Cardiovascular Interventions, the outcomes of 2,534 patients (29.1%; 3,871 lesions [31.5%]) with stents implanted in the proximal LAD were compared to outcomes of 6,172 patients (70.9%; 8,419 lesions [68.5%]) with stents implanted outside the proximal LAD.
The investigators reported that at the 4-year follow-up, mortality rates were the same (5.8% vs 5.8%; P > .999), but more myocardial infarctions occurred in the proximal LAD group (6.2% vs 4.9%; P = .015). The rates of clinically driven target vessel failure (TVF) (14.8% vs 13.5%; P = .109), major adverse cardiac events (MACE) (15% vs 13.7%; hazard ratio, 1.1; 95% confidence interval, 0.97–1.31; P = .139), and stent thrombosis (2.1% vs 2%; P = .8) were similar. DES type had no interaction with MACE or TVF. In multivariate analysis, the proximal LAD was a predictor of myocardial infarction (P = .038), but not of TVF (P = .149) or MACE (P = .069).
The study demonstrated that in contemporary PCI the proximal LAD location was associated with higher rates of myocardial infarction during the long-term follow-up, but there were no differences in stent thrombosis, death, TVF, or overall MACE. This finding may suggest that, in the DES era, proximal LAD no longer confers a different prognosis than other lesion sites, advised the investigators in JACC: Cardiovascular Interventions.