Outcomes Among Patients Undergoing Distal Left Main Percutaneous Coronary Intervention

Area of Science:

• Interventional Cardiology
• Cardiovascular Research
• Medical Device Technology

Background:

• Distal left main (LM) coronary artery bifurcation disease presents challenges in percutaneous coronary intervention (PCI).
• Optimal treatment strategies for distal LM disease remain under investigation.
• PCI for LM bifurcation lesions is associated with higher complexity and potentially worse outcomes.

Purpose of the Study:

• To compare outcomes of provisional 1-stent versus planned 2-stent techniques for distal LM bifurcation lesions.
• To investigate if lesion complexity influences the effectiveness of different stenting strategies.
• To evaluate 3-year clinical outcomes in patients undergoing PCI for distal LM disease.

Main Methods:

• Analysis of data from the EXCEL trial (NCT01205776).
• Comparison of clinical and angiographic characteristics, procedural methods, and 3-year outcomes.
• Stratification of patients based on treatment technique (provisional 1-stent vs. planned 2-stent) and lesion complexity.

Main Results:

• The primary composite endpoint (death, MI, stroke) at 3 years was significantly lower with the provisional 1-stent technique (14.1%) versus planned 2-stent (20.7%).
• This benefit was driven by reduced cardiovascular death and myocardial infarction in the provisional group.
• A lower rate of ischemia-driven revascularization was observed with the provisional approach (7.2% vs. 16.3%).

Conclusions:

• In the EXCEL trial, PCI for distal LM bifurcation disease with a provisional 1-stent strategy resulted in better 3-year outcomes compared to a planned 2-stent approach.
• The benefit of the provisional strategy was observed in patients without major involvement of both LM side branch vessels.
• Planned 2-stent treatment was associated with worse outcomes in this patient cohort.