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.


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Cardiac Interventions Today (ISSN 2572-5955 print and ISSN 2572-5963 online) is a publication dedicated to providing comprehensive coverage of the latest developments in technology, techniques, clinical studies, and regulatory and reimbursement issues in the field of coronary and cardiac interventions. Cardiac Interventions Today premiered in March 2007 and each edition contains a variety of topics in a flexible format, including articles covering various perspectives on current clinical topics, in-depth interviews with expert physicians, overviews of available technologies, industry news, and insights into the issues affecting today's interventional cardiology practices.