Deferred Versus Performed Revascularization for Left Main Coronary Disease With Hemodynamic Significance

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Left main coronary artery disease (LMD) is often excluded from major trials, leaving outcomes data scarce.
• Understanding the long-term results of treating significant LMD with ischemia is crucial.

Purpose of the Study:

• To compare long-term clinical outcomes of revascularization versus deferral in patients with stable, physiologically significant LMD.

Main Methods:

• An international multicenter registry analyzed stable LMD patients with ischemia (iFR ≤0.89).
• Patients were divided into revascularization (n=151) and deferral (n=74) groups.
• Propensity score matching adjusted for baseline characteristics; primary endpoint was MACE (death, MI, ischemia-driven TVR).

Main Results:

• At 2.8 years, the primary endpoint occurred in 14.9% of revascularized vs. 28.4% of deferred patients (HR 0.42, P=0.023).
• Cardiac death/MI was lower in the revascularized group (0.0% vs. 8.1%, P=0.004).
• Ischemia-driven LMTVR was significantly lower post-revascularization (5.4% vs. 17.6%, HR 0.20, P=0.012).

Conclusions:

• Revascularization significantly improves long-term clinical outcomes in stable LMD patients with significant ischemia.
• Deferred treatment for significant LMD carries a higher risk of adverse cardiac events.