Management Strategies and Outcomes in Diffuse LAD CAD Among the Asian Population: A Prospective Study

https://doi.org/10.5281/zenodo.18203941

Abstract

Background: Diffuse left anterior descending (LAD) coronary artery disease (CAD) involves long, contiguous stenoses and may require extensive percutaneous or surgical revascularization; data from South Asia are limited.

Objective: To describe management strategies and in-hospital outcomes in consecutive diffuse LAD CAD.

Methods: We conducted a prospective, registry-based cohort study at the Peshawar Institute of Cardiology using the Cardiac Registry of Pakistan (1^st March 2024 till 31^st March 2025). Consecutive adults undergoing coronary angiography were screened in real time for diffuse LAD disease (lesion/contiguous lesions ≥20 mm with ≥70% stenosis extending into the mid-to-distal LAD). Patients were grouped by index LAD strategy during the same hospitalization: PCI with drug-eluting stent (DES), PCI with drug-eluting balloon (DEB), PCI with plain old balloon angioplasty (POBA), coronary artery bypass grafting (CABG) alone, hybrid revascularization (PCI plus CABG), or medical therapy. The primary outcome was in-hospital all-cause mortality; secondary outcomes were in-hospital myocardial infarction, stroke, urgent repeat revascularization, and length of stay.

Results: Among 470 enrolled patients (61.6±9.8 years; 67.8% male), hypertension and diabetes were present in 53.6% and 24.5%, respectively. PCI was used in 94.7% (DES 90.2%, DEB 5.3%, POBA 4.5%). CABG alone (0.6%), hybrid revascularization (1.1%), and medical therapy (1.5%) were uncommon. Overall, in-hospital mortality was 1.1% (5/470); all deaths occurred in the DES-PCI group, with no deaths in the other strategies.

Conclusion: In this prospective South Asian registry, PCI—predominantly DES—was the prevailing approach for diffuse LAD CAD and was associated with low in-hospital mortality. Longer-term multicenter studies are needed to compare durability and late outcomes across strategies.