Related Experiment Video
Updated: Nov 14, 2025
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Practice and long-term outcome of unprotected left main PCI: real-world data from a nationwide registry
Peter Kayaert1, Mathieu Coeman2, Claude Hanet3
1Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium.
Insights
Percutaneous coronary intervention for left main lesions has high mortality. Higher operator experience and transradial access (TRA) in left main PCI are linked to improved patient survival.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Left main (LM) coronary artery disease requires intervention due to poor prognosis.
- Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are treatment options with associated risks.
- Long-term outcome data are crucial for guiding treatment decisions in LM lesions.
Purpose of the Study:
- To evaluate the trends and long-term outcomes of LM PCI.
- To identify predictors of mortality in patients undergoing LM PCI.
Main Methods:
- A national registry prospectively enrolled 5284 patients undergoing LM PCI between 2012 and 2019.
- Exclusion criteria included prior CABG, prior LM PCI, cardiogenic shock, or out-of-hospital cardiac arrest.
- Baseline, procedural data, and long-term survival were assessed.
Main Results:
- LM PCI rates increased, with greater adoption of transradial access (TRA).
- All-cause mortality was 6.0% at 30 days and 18.5% at 33.5 months follow-up.
- Predictors of mortality included older age, diabetes, multivessel disease, urgent indication, suboptimal results, and non-exclusive drug-eluting stent use. TRA and higher operator/center experience were linked to lower mortality.
Conclusions:
- LM PCI is associated with significant short- and long-term mortality.
- Increased operator experience and the use of TRA in LM PCI correlate with improved survival outcomes.
Background:
Percutaneous coronary intervention (PCI) is increasingly performed in significant left main (LM) lesions. Left untreated, the prognosis is poor, but PCI and coronary bypass surgery (CABG) behold risks as well. Additional long-term outcome data might guide future treatment decisions.
Methods:
Between 2012 and 2019, all 6783 patients who underwent LM PCI were prospectively enrolled in a national registry. Patients with prior CABG or prior LM PCI, and patients presenting in cardiogenic shock or after out-of-hospital cardiac arrest were excluded. From the remaining 5284 patients, baseline and procedural data as well as long-term survival were assessed.
Results:
The annual rate of LM PCI increased from 422 (2.2% of PCIs) in 2012 to 868 in 2018 (3.0%). By 2018, 71% of the interventional cardiologists performed at least 1 LM PCI a year, though only 5 on average. Use of transradial access (TRA) in LM PCI increased from 20.4% in 2012 to 59.5% in 2019. All-cause mortality was 6.0% at 30 days and 18.5% at a mean follow-up of 33.5 months. Independent predictors of higher long-term mortality were older age, diabetes, multivessel disease, an urgent indication, a suboptimal angiographical result, and non-exclusive use of drug-eluting stents. TRAand higher operator and centre LM PCI experience were independent predictors of a lower long-term mortality.
Conclusion:
LM PCI is associated with high short- and long-term mortality. Use of TRA and higher expertise in LM PCI were associated with better survival.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:24Cardiac Catheterization III: Left Heart Catheterization
01:27Peripheral Artery Disease III: Interprofessional Care