Key result
LM-PCI maintains a stable ~14% long-term MACE rate, strongly predicted by emergent procedures and cardiogenic shock.
Why the study?
CABG is the gold standard for left main disease, but PCI has emerged as an alternative in patients with advanced age, comorbidities, and moderate complexity.
Over a 12-year period, LM-PCI volume and complexity increased while in-hospital MACE rates remained stable, with emergent procedures and cardiogenic shock strongly predicting adverse outcomes.
Supports elective LM-PCI in stable patients; extends real-world evidence of stable outcomes despite rising volume and complexity.
Background CABG is the gold standard for LM disease, yet PCI has become an alternative in patients with advanced age, comorbidities, and moderate complexity. Objectives To assess temporal trends and in-hospital outcomes of non-CABG eligible patients undergoing left-main (LM-) PCI over a 12-year period. Methods We retrospectively analyzed consecutive patients undergoing LM-PCI between 2012 and 2023 at a single center. Patients were grouped into temporal tertiles (2012-2014, 2015-2017, 2018-2020, 2021-2023). The primary endpoint was in-hospital MACE (death, myocardial infarction, stroke). Safety endpoints included bleeding, infection, kidney or heart failure. Independent predictors of MACE were assessed using Cox regression. Results 824 patients were included with a median age was 76 years; 71% male. Nearly half had preserved LVEF, while 25% had severely reduced LVEF, declining from 38% to 19% over time. LM-PCI volume nearly doubled, mainly for NSTEMI (29%). Two-stent techniques rose from 9% to 31%, radial access from 7% to 61%. IVUS and proximal optimization were increasingly used. Protected PCI was more common in acute vs. elective cases (25% vs. 0.3%). MACE occurred in 13.9%, mainly driven by mortality (11%). MACE rates remained stable with a nonsignificant downward trend across tertiles, primarily due to fewer Type4a infarction. Elective LM-PCI was associated with a very low MACE rate of 2.2%. In multivariable analysis emergent procedures (HR 5.72, 95% CI 3.46, 9.46) and cardiogenic shock (HR 3.38, 95% CI 1.86, 6.14) independently predicted MACE, whereas preserved LVEF >50% was protective (HR 0.19, 95% CI 0.10, 0.36). Conclusions Over 12 years, LM-PCI volume and complexity increased with broader use of advanced techniques. Despite older age and comorbidities, MACE rates remained stable with a nonsignificant downward trend. Emergent PCI, cardiogenic shock, and reduced LVEF were strong independent predictors of MACE.
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Abdennadher et al. (2026) studied this question. Left main percutaneous coronary intervention maintained a stable 13.9% MACE rate over 12 years, with emergent procedures (HR 5.72) and cardiogenic shock (HR 3.38) strongly predicting MACE.
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