Results and long-term predictors of adverse clinical events after elective percutaneous interventions on unprotected...

Area of Science:

• Interventional Cardiology
• Cardiovascular Medicine
• Vascular Surgery

Background:

• The safety and efficacy of percutaneous coronary intervention (PCI) for de novo lesions in unprotected left main coronary arteries (ULMCAs) is a critical clinical question.
• Unprotected LMCA disease poses significant risks, making treatment decisions complex.

Purpose of the Study:

• To evaluate the feasibility, procedural safety, and long-term outcomes of elective PCI for de novo lesions in ULMCAs.
• To identify predictors of adverse events in patients undergoing PCI for ULMCAs.

Main Methods:

• A retrospective analysis of 67 consecutive patients treated with PCI for de novo ULMCA lesions.
• Various devices were used, including stents, rotational atherectomy, and directional coronary atherectomy.
• In-hospital and long-term follow-up data, including clinical events and repeat revascularization, were collected.

Main Results:

• The procedure demonstrated feasibility with a low in-hospital complication rate (3.0% CABG, 3.0% Q-wave MI, 4.5% non-Q-wave MI).
• Three-year estimated cardiac survival was 91%.
• Angiographic restenosis occurred in 31.4% of patients, and cumulative repeat revascularization was 23.9% at extended follow-up. Higher Parsonnet scores predicted increased cardiac mortality.

Conclusions:

• Elective PCI for de novo ULMCA lesions is technically feasible with acceptable procedural risk.
• Despite initial feasibility, long-term follow-up reveals significant rates of restenosis and repeat revascularization, alongside a notable incidence of cardiac death.
• Preserved left ventricular ejection fraction and larger reference vessel size are key predictors of favorable long-term outcomes.