Key result
Routine intracoronary imaging-guided left main percutaneous coronary intervention resulted in a 1-year MACCE rate of 17.5%, with low rates of target lesion revascularization (2.0%) and cardiac death (3.4%).
Why the study?
Routine intracoronary imaging guidance is recommended for left main PCI, but its real-world effectiveness remains unclear.
Observational (n=743)
Yes
In real-world practice, routine imaging-guided left main PCI yields favorable low rates of target lesion revascularization and cardiac death, though complex bifurcation stenting and severe LV dysfunction remain significant risk factors.
May support imaging-guided left main PCI in real-world practice with low TLR and death rates; leaves open need for randomized confirmation versus angiography alone.
Left main (LM) percutaneous coronary intervention (PCI) with routine intracoronary imaging guidance is recommended; however, its real-world effectiveness remains unclear. A total of 743 consecutive patients undergoing drug-eluting stent implantation for de novo unprotected LM lesions across 19 Japanese National Hospital Organization hospitals where routine imaging guidance was adopted were analyzed. The primary endpoint was 1-year major adverse cardiovascular and cerebrovascular events (MACCE), comprising all-cause death, cerebrovascular disorder, clinical-driven revascularization, and myocardial infarction. In this cohort, acute coronary syndrome was present in 31.2%, with 39.3% classified as Canadian Cardiovascular Society functional angina (CCS) class ≥ III. LM bifurcation lesions were observed in 78.0%, with two-stent implantation in 8.8%. MACCE occurred in 17.5%, with target lesion revascularization and cardiac death rates of 2.0% and 3.4%, respectively. Independent risk factors for MACCE included two-stent implantation (hazard ratio [HR], 2.49), mechanical cardiac support device use (HR, 2.17), CCS class ≥ III (HR, 2.07), 10% increase in left ventricular ejection fraction (HR, 0.72), and radial access (HR, 0.62). Routine imaging-guided LM-PCI is associated with favorable low rate of target lesion revascularization and cardiac death. However, severe left ventricular dysfunction and LM bifurcation treated with two-stent implantation increase risks, requiring more comprehensive management.
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Murasato et al. (2025) conducted an observational in De novo unprotected left main coronary lesions (n=743). Routine intracoronary imaging-guided left main percutaneous coronary intervention was evaluated on 1-year major adverse cardiovascular and cerebrovascular events (MACCE). Routine intracoronary imaging-guided left main percutaneous coronary intervention resulted in a 1-year MACCE rate of 17.5%, with low rates of target lesion revascularization (2.0%) and cardiac death (3.4%).
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