Long-term outcome between two different revascularization strategies for patients with left main coronary artery disease and concomitant chronic total occlusion of right coronary artery disease

OBJECTIVES: Percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease is technically demanding if there is a concomitant chronic total occlusion (CTO) of the right coronary artery (RCA). Which vessel to be revascularized in first attempt was not evaluated before. METHODS: We included 32 845 patients who received coronary angiography in Taipei Veterans General Hospital between January 2011 and December 2020. A total of 135 patients had both LMCA disease and RCA CTO. We compared two revascularization strategies of recanalization: one that revascularized the RCA CTO first and one that received LMCA PCI first. RESULTS: A total of 107 patients received revascularization of the LMCA first, and 28 patients received RCA CTO PCI first. There was no difference in periprocedural (cardiogenic shock and cardiac tamponade) (18 vs. 20%; P = 1.000 and 0 vs. 2%; P = 1.000, respectively) and in-hospital complications (acute kidney injury, acute respiratory failure, and in-hospital mortality) (7 vs. 7%; P = 1.000, 0 vs. 6%; P = 0.343, and 7 vs. 7%; P = 1.000, respectively). Three-year major adverse cardiocerebrovascular event (MACE) was not statistically different between the two groups (18 vs. 25%; P = 0.197). Three-year MACE was statistically significantly lower in the complete revascularization group (both LMCA PCI and successful RCA CTO PCI) than in the partial revascularization group (LMCA PCI only) (16 vs. 28%; P = 0.017). CONCLUSION: In patients with LMCA disease and concomitant RCA CTO, LMCA PCI did not differ from RCA CTO PCI in the first attempt in terms of periprocedural, in-hospital, 3-year all-cause mortality, and 3-year MACE.