Treatment of Additional Vessels During Percutaneous Coronary Intervention for Unprotected Left Main Disease: Insights...

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Percutaneous coronary intervention (PCI) is a viable alternative to coronary artery bypass grafting for unprotected left main (LM) coronary artery disease (CAD).
• The safety and impact of treating additional non-LM vessels during LM-PCI remain areas of clinical interest.

Purpose of the Study:

• To evaluate the safety and clinical outcomes of treating additional coronary arteries concurrently with LM-PCI.
• To compare the incidence of major adverse cardiovascular events (MACE) in patients undergoing LM-PCI alone versus those with concomitant PCI of an additional non-LM vessel.

Main Methods:

• Retrospective analysis of consecutive patients undergoing PCI with drug-eluting stents for unprotected LM-CAD from 2010-2021.
• Patients were stratified into two groups: LM complex PCI alone and LM complex PCI with concomitant PCI of an additional non-LM vessel.
• The primary outcome was MACE (composite of death, myocardial infarction, or stroke) at 1-year post-PCI.

Main Results:

• A total of 869 patients were included; 55.1% underwent LM-PCI alone, and 44.9% had concomitant PCI of an additional vessel.
• There were no significant differences in the 1-year MACE rate between the two groups (12.0% vs 13.3%; HR: 0.95; 95% CI [0.62-1.44]).
• Adjusted analysis also showed no significant difference in MACE rates (HR: 0.87; 95% CI [0.56-1.36]), indicating comparable safety.

Conclusions:

• In a real-world cohort, treating an additional non-LM vessel during unprotected LM-PCI does not increase the risk of 1-year MACE.
• Concomitant PCI of additional non-LM vessels is a safe strategy in select patients undergoing LM-PCI.
• These findings support the consideration of multi-vessel PCI in appropriate patients with unprotected LM-CAD.