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

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.