Different lesion preparation strategies during left main PCI resulted in comparable 3-year MACE rates, ranging from 14.5% to 20.2% across the four strategy groups (p=0.50).
Cohort (n=938)
Does the choice of lesion preparation strategy affect 3-year MACE in patients undergoing left main coronary artery PCI?
Different lesion preparation strategies for left main PCI yield comparable 3-year MACE rates, suggesting that tailored preparation can effectively mitigate the risks associated with complex lesion morphology.
p-value: p=.50
Abstract Objectives We examined outcomes according to lesion preparation strategy (LPS) in patients with left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in the EXCEL trial. Background The optimal LPS for LMCA PCI is unclear. Methods We categorized LPS hierarchically (high to low) as: (a) rotational atherectomy (RA); (b) cutting or scoring balloon (CSB); (c) balloon angioplasty (BAL); and d) direct stenting (DIR). The primary endpoint was 3‐year MACE; all‐cause death, stroke, or myocardial infarction. Results Among 938 patients undergoing LMCA PCI, RA was performed in 6.0%, CSB 9.5%, BAL 71.3%, and DIR 13.2%. In patients treated with DIR, BAL, CSB, and RA, respectively, there was a progressive increase in SYNTAX score, LMCA complex bifurcation, trifurcation or calcification, number of stents, and total stent length. Any procedural complication occurred in 10.4% of cases overall, with the lowest rate in the DIR (7.4%) and highest in the RA group (16.1%) ( p trend = .22). There were no significant differences in the 3‐year rates of MACE (from RA to DIR: 17.9%, 20.2%, 14.5%, 14.7%; p = .50) or ischemia‐driven revascularization (from RA to DIR: 16.8%, 10.8%, 12.3%, 14.2%; p = .65). The adjusted 3‐year rates of MACE did not differ according to LPS. Conclusions The comparable 3‐year outcomes suggest that appropriate lesion preparation may be able to overcome the increased risks of complex LMCA lesion morphology.
Beohar et al. (Sat,) conducted a cohort in Left main coronary artery (LMCA) percutaneous coronary intervention (PCI) (n=938). Lesion preparation strategy (rotational atherectomy, cutting/scoring balloon, balloon angioplasty, direct stenting) vs. Other lesion preparation strategies was evaluated on 3-year MACE; all-cause death, stroke, or myocardial infarction (p=.50). Different lesion preparation strategies during left main PCI resulted in comparable 3-year MACE rates, ranging from 14.5% to 20.2% across the four strategy groups (p=0.50).