Long-term clinical impact of angiographic complexity in left main trifurcation percutaneous coronary interventions

Current evidence on the long-term outcome and its determinants in patients with unprotected left main trifurcation (LMT) treated with percutaneous coronary intervention (PCI) is based on small-sized studies. We aimed to assess the clinical, anatomical and procedural factors impacting long-term clinical outcomes of patients with LMT treated by PCI.

We conducted a multicenter retrospective study on consecutive patients with unprotected LMT in stable or acute coronary settings who underwent PCI with drug-eluting-stent implantation. Primary endpoint was major adverse cardiovascular events (MACE), defined as composite of all-cause death, myocardial infarction, and target lesion revascularization. LMT lesions complexity was graded according to a modified Medina LMT score, which, together with standard criteria of >50% stenosis in any of the branches, included the presence of disease extent >5 mm in the two major side-branches.

A total of 103 patients were analyzed, mean age 67.5 years, 37.9% with diabetes mellitus, 47.6% presenting with acute coronary syndrome, 8.7% in cardiogenic shock, with a mean SYNTAX Score of 28.1. Procedural success (angiographic success without in-hospital MACE) was achieved in 99 patients (96.1%). During 3-year follow-up, 18 patients (17.9%) experienced MACE, mainly due to target lesion revascularization (TLR), which occurred in 12 patients (11.9%). At multivariable analysis, modified Medina LMT score was the only independent predictor of MACE (HR 1.538 [1.081-2.189], P=0.017).

PCI in patients with LMT is associated with a high procedural success rate and acceptable long-term clinical outcomes. Baseline LMT lesion complexity, assessed by an original modified Medina LMT score, is an independent driver of long-term clinical outcomes.