Related Experiment Video
Updated: Dec 8, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Angiographic Results After Percutaneous Coronary Interventions in Ostial Versus Distal Left Main Lesions
Tilman Stephan1, Mirjam Keßler1, Nadine Goldberger1
1Department of Cardiology, Angiology and Pneumology, University Hospital Ulm, Ulm, Germany.
Insights
Percutaneous coronary intervention (PCI) for distal left main (LM) bifurcation lesions has higher rates of target lesion revascularization and restenosis compared to ostial LM lesions. Late lumen loss in distal LM bifurcations is an independent predictor of major adverse cardiac events.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Imaging
Background:
- Left main (LM) coronary artery disease is a critical condition requiring effective treatment.
- Percutaneous coronary intervention (PCI) is a common revascularization strategy for LM disease.
- Understanding angiographic outcomes in different LM lesion locations is crucial for optimizing PCI strategies.
Purpose of the Study:
- To compare angiographic outcomes between ostial and distal left main (LM) lesions after PCI.
- To identify predictors of adverse events in patients with LM disease undergoing PCI.
Main Methods:
- Retrospective analysis of 176 patients with LM disease undergoing PCI.
- Quantitative coronary analysis (QCA) using an 11-segment model.
- 12-month clinical follow-up for major adverse cardiac events (MACE), including cardiac death, myocardial infarction, and target lesion revascularization (TLR).
Main Results:
- Distal LM bifurcation lesions showed higher rates of MACE, primarily driven by increased TLR (14.1% vs. 5.6%).
- Angiographic restenosis (8.2% vs. 0.0%) and late lumen loss (LLL) were significantly higher in distal LM bifurcation lesions.
- LLL in bifurcation segments and diabetes mellitus were independent predictors of MACE in distal LM lesions.
Conclusions:
- PCI of ostial LM lesions is associated with favorable angiographic outcomes.
- Distal LM bifurcation lesions exhibit higher rates of LLL and binary restenosis, particularly in segments near the bifurcation.
- Late lumen loss in bifurcation segments is a significant predictor of adverse events after PCI for distal LM lesions.
Purpose:
We sought to evaluate angiographic outcomes in ostial and distal LM lesions.
Methods:
176 patients with LM disease undergoing PCI were retrospectively included in this study. 9 months of angiographic and 12 months of clinical follow-up was obtained. Quantitative coronary analysis (QCA) was performed for all lesions, using an 11-segment model. Clinical endpoint measure was a composite endpoint of cardiac death, myocardial infarction and target lesion revascularization (TLR).
Results:
During 12 months follow up after successful PCI, the composite endpoint occurred more frequently in distal LM bifurcation lesions mainly driven by elevated TLR rates (14.1% in distal LM disease vs. 5.6% in ostial/midshaft LM disease, P = 0.20). Concordantly angiographic binary restenosis (8.2% compared to 0.0%) and late lumen loss (LLL, 0.42 ± 0.97 vs. 0.28 ± 0.34 mm) were increased in distal LM bifurcation lesions compared to ostial LM lesions. In distal lesions highest values for LLL were observed in segments adjacent to the bifurcation (0.37 ± 1.13 mm and 0.37 ± 0.73 mm). On cox proportional regression analysis the angiographic parameter LLL in a bifurcation segment (P = 0.03, HR 1.68 [1.1-2.7]) as well as presence of diabetes mellitus as a clinical parameter (P = 0.046, HR 2.77 [1.0-7.5]) were independent correlates for occurrence of MACE in distal LM bifurcations lesions.
Conclusion:
PCI of ostial LM in accomplished with low LLL (0.28 ± 0.34 mm) and binary restenosis rates. In distal left main lesions highest rates for LLL and binary restenosis were observed in segments nearest to the bifurcation and rather focused on the main vessel (0.42 ± 0.97 mm).
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:24Cardiac Catheterization III: Left Heart Catheterization