July 15, 2025Journal of Personalized MedicineOpen Access

Long-Term Outcome of Unprotected Left Main Percutaneous Coronary Interventions—An 8-Year Single-Tertiary-Care-Center Experience

View Full Paper

Ask AI

Bookmark

Why the study?

Randomized studies of patients with unprotected left main coronary artery disease involve highly selected populations.

Does acute versus elective presentation affect long-term event-free survival in patients undergoing unprotected left main coronary artery PCI?

Structured PICO

Does acute versus elective presentation affect long-term event-free survival in patients undergoing unprotected left main coronary artery PCI?

Population

513 consecutive patients undergoing unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI), mean age 68 ± 12 years, 64% male, including 157 elective and 356 acute cases, at a single tertiary care center.

Intervention

Unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI)

Comparator

Elective versus acute presentation

Outcome

Time to cardiac death, target lesion myocardial infarction, or target lesion revascularization (whichever came first) with a follow-up of 60 monthscomposite

Acute ULMCA PCI patients have a significantly worse 60-month prognosis compared to elective patients, and clinical/procedural parameters are important predictors of event-free survival alongside anatomical complexity.

Implication

Acute presentation linked to higher long-term events after ULMCA PCI; leaves open acuity-specific risk stratification pending prospective validation.

Abstract

Background/Objectives: Randomized studies of patients with unprotected left main coronary artery (ULMCA) disease involve highly selected populations. Therefore, we sought to investigate the 60-month event-free survival of consecutive patients undergoing ULMCA percutaneous coronary intervention (PCI) and determine the best risk score system and independent predictors of event-free survival. Methods: All patients who underwent ULMCA PCI at our center between 1 January 2007 and 31 December 2014 were included. The primary endpoint was the time to cardiac death, target lesion myocardial infarction, or target lesion revascularization (whichever came first) with a follow-up of 60 months. Results: A total of 513 patients (mean age 68 ± 12 years, 64% male, 157 elective, 356 acute) underwent ULMCA PCI. The 60-month incidence of events was 16.8% and 38.0% in elective and acute patients, respectively. There were significantly more events in the acute group during the first 6.5 months. Of the risk scores, the ACEF (AUC = 0.786) and SYNTAX II (AUC = 0.716) scores had the best predictive power in elective and acute patients, respectively. The SYNTAX score proved to be the least predictive in both groups (AUC = 0.638 and 0.614 in the elective and acute groups, respectively). Left ventricular function (hazard ratio (HR) for +10% 0.53 [95% CI, 0.38–0.75] and 0.81 [95% CI, 0.71–0.92] in elective and acute patients, respectively) and, in acute patients, access site (femoral vs. radial HR 1.76 [95% CI, 1.11–2.80]), hyperlipidemia (HR 0.58 [95% CI, 0.39–0.86]), and renal function (HR for +10 mL/min/1.73 m2 higher GFR: 0.87 [95% CI, 0.78–0.97]) were independent predictors of event-free survival. Conclusions: Acute ULMCA PCI patients have worse prognosis than elective patients, having more events during the first 6.5 months. Besides anatomical complexity, clinical and procedural parameters determine the prognosis.