What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Coronary Syndrome (ACS) (n=101). Intervention: PCI for left main coronary artery (LMCA) lesions vs. PCI for non-LMCA lesions. Primary outcome: Major adverse cardiovascular events (MACE: composite of myocardial infarction, stroke, and sudden cardiac death) (p=0.013).

August 31, 2025Open Access

Outcome of Percutaneous Coronary Intervention for Left Versus Non-left Main Coronary Artery in Acute Coronary Syndrome: A Comparative Study

Key Result

Patients undergoing percutaneous coronary intervention for acute coronary syndrome involving the left main coronary artery experienced a significantly higher rate of major adverse cardiovascular events at 12 months compared to those with non-left main lesions (5.9% vs 2.0%, p=0.013).

Study Design

Type

Cohort (n=101)

Multicenter

Structured PICO

Does PCI for left main coronary artery (LMCA) lesions compared to non-LMCA lesions increase the risk of major adverse cardiovascular events in patients with acute coronary syndrome?

Population

101 adult patients with acute coronary syndrome who underwent percutaneous coronary intervention for left main versus non-left main culprit lesions, followed for 12 months.

Exposure

Percutaneous coronary intervention (PCI) for culprit lesions involving the left main coronary artery (LMCA). Patients received standard periprocedural therapy including aspirin, P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor), high-intensity statin, and anticoagulation.

Comparator

Percutaneous coronary intervention (PCI) for culprit lesions in coronary arteries other than the LMCA (non-LMCA). Patients received the same standard periprocedural and post-procedural medical therapy.

Outcome

Major adverse cardiovascular events (MACE), defined as a composite of myocardial infarction, stroke, and sudden cardiac death at 12 months follow-up, adjudicated by two independent cardiologists.composite

In patients with acute coronary syndrome, PCI for left main coronary artery lesions is associated with a significantly higher 12-month risk of major adverse cardiovascular events compared to non-left main lesions.

Main Result

Absolute Event Rate: 5.88% vs 2%

p-value: p=0.013

Limitations

Routine clinical practice setting using convenience sampling resulted in differences in baseline characteristics among the groups.
Relatively small sample size from a single center restricts generalizability.
Low post-hoc power (16.6%) due to small sample size and low event rates limits the ability to detect significant differences in rare outcomes.
Follow-up period was limited to 12 months.
Lack of routine intravascular ultrasound (IVUS) use due to cost constraints in the acute clinical setting.

Abstract

BACKGROUND AND OBJECTIVE: Acute coronary syndromes (ACS), particularly those affecting the left main coronary artery (LMCA), are associated with high morbidity and mortality. The objective of the present study was to investigate long-term outcomes in patients who underwent percutaneous coronary intervention (PCI) for ACS affecting the LMCA compared to those with non-LMCA involvement. METHODS: This interventional study was conducted at the Department of Cardiology of MH Shamorita Medical College Hospital in Dhaka, Bangladesh, from January 2023 to June 2024. A total of 101 patients with ACS who underwent PCI participated in the study. Of whom, 51 were in the LMCA group and 50 were in the non-LMCA group. Follow-up assessment was done at the third, sixth, and 12th months, focusing on major adverse cardiovascular events (MACE) as the primary endpoint and persistent symptoms, repeat revascularization, and stent thrombosis as secondary endpoints. RESULTS: The mean age of the LMCA and non-LMCA groups was 56 and 54 years, respectively, with a higher female proportion in the LMCA group. The patients in the LMCA group presented with more complex lesions, with a mean synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score of 23.6. The MACE rate was notably higher in the LMCA group at 6%, compared to 2% in the non-LMCA group (p=0.013). Myocardial infarction (MI) occurred in 4% of the LMCA group, with no events in the non-LMCA group. Persistent symptoms and repeat revascularization were also more prevalent in the LMCA group (6% and 4%, respectively, p-value <0.05). CONCLUSIONS: Patients with ACS involving the LMCA experienced higher rates of adverse outcomes, particularly MI and repeat revascularization, following PCI compared to non-LMCA cases.

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