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Impact of Polyvascular Disease in Patients Undergoing Unprotected Left Main Percutaneous Coronary Intervention

Benjamin Bay1, Raman Sharma2, Anastasios Roumeliotis2

  • 1Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

The American Journal of Cardiology
|May 2, 2024
PubMed

Insights

Patients with polyvascular disease (PolyVD) undergoing left main percutaneous coronary intervention (LM-PCI) face higher risks of major adverse cardiovascular events (MACE) and bleeding. This highlights the vulnerability of this complex patient group post-procedure.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Percutaneous coronary intervention (PCI) is effective for select left main coronary artery disease (LM-CAD) patients.
  • Polyvascular disease (PolyVD), involving multiple vascular beds, is linked to worse outcomes in coronary artery disease (CAD).
  • The impact of PolyVD on outcomes after LM-PCI remains understudied.

Purpose of the Study:

  • To investigate the association between PolyVD and outcomes following unprotected LM-PCI.
  • To evaluate the risk of major adverse cardiovascular events (MACE) and bleeding in LM-PCI patients with and without PolyVD.

Main Methods:

  • Retrospective single-center study of patients undergoing unprotected LM-PCI (2012-2019).
  • Patients stratified based on the presence or absence of PolyVD (LM-CAD plus cerebrovascular and/or peripheral artery disease).
  • Primary outcome: MACE (all-cause mortality or spontaneous myocardial infarction) within 1 year post-PCI.

Main Results:

  • 869 patients included; 23.8% had PolyVD.
  • PolyVD patients were older with more comorbidities.
  • Higher 1-year MACE rates (22.8% vs 9.4%, p<0.001) and bleeding events in PolyVD group.
  • MACE driven by increased all-cause mortality (18.3% vs 7.1%, p<0.001) in PolyVD group.
  • Results remained significant after adjusting for confounders.

Conclusions:

  • PolyVD is an independent predictor of increased MACE and bleeding risk after LM-PCI.
  • Patients with PolyVD undergoing LM-PCI represent a vulnerable population requiring careful management.
  • Further research into optimizing treatment strategies for this high-risk group is warranted.

Keywords:
bleedingcerebrovascular diseasecoronary artery diseasemortalitymyocardial infarctionperipheral artery disease

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