title: Revascularization for Left Anterior Descending Artery Stenosis: A Review of the Evidence That Supports Practice.
abstract: Disease of the proximal left anterior descending (LAD) artery is a common pathological finding often combined with disease in other coronary arteries. In this article, we review specifically the evidence (and the guidelines arising from the data) for lesions isolated to the proximal LAD only. Critical review of the data reveals limitations with few trials that reflect contemporary practice. Much of the data are observational rather than from randomized trials, and therefore subject to bias. We identified 2 randomized trials of drug-eluting stents versus left internal mammary artery grafting for isolated lesions of the proximal LAD. One reported no difference in major adverse cardiovascular events, but at an early timepoint (6 months), which is likely to be too early to reveal treatment differences. In the second trial, target lesion revascularization excess was noted in the drug-eluting stent arm. Therefore, at the current time, there are little data available to inform interventional cardiologists as to the best revascularization strategy for isolated lesions of the proximal LAD. Further randomized, controlled trials are needed.
authors.affiliation: From the *Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK; †Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK; ‡Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK; and §Department of Cardiothoracic Surgery, Royal Brompton Hospital, Sidney Street, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Kinnaird
authors.forename: Richard
authors.initials: R
authors.lastname: Anderson
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ossei-Gerning
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.forename: Neil
authors.initials: N
authors.lastname: Moat
mesh_terms: D003324:Coronary Artery Disease / Q000628:therapy*; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods*; D017410:Practice Guidelines as Topic