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Updated: May 21, 2025

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Routine intracoronary imaging-guided left main coronary intervention.

Yoshinobu Murasato1, Hitoshi Nakashima2, Hiroshi Sugino3

  • 1Department of Cardiology, National Hospital Organization Kyushu Medical Center, 1-8-1, Jigyohama, Chuo, Fukuoka, 810-8563, Japan. y.murasato@gmail.com.

Scientific Reports
|March 20, 2025
PubMed
Summary
This summary is machine-generated.

Routine imaging guidance for left main percutaneous coronary intervention (PCI) shows favorable outcomes, but complex cases like bifurcations and severe left ventricular dysfunction increase risks. Comprehensive management is crucial for optimal results in these patients.

Keywords:
Intracoronary imagingLeft main coronary arteryMajor adverse cardiovascular and cerebrovascular eventsPercutaneous coronary intervention

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Left main (LM) percutaneous coronary intervention (PCI) with routine intracoronary imaging guidance is recommended.
  • The real-world effectiveness of this approach for de novo unprotected LM lesions is not well-established.

Purpose of the Study:

  • To evaluate the real-world effectiveness of routine intracoronary imaging guidance in patients undergoing drug-eluting stent implantation for de novo unprotected LM lesions.
  • To identify risk factors associated with major adverse cardiovascular and cerebrovascular events (MACCE) in this patient cohort.

Main Methods:

  • A retrospective analysis of 743 consecutive patients undergoing LM-PCI with routine imaging guidance across 19 Japanese hospitals.
  • Primary endpoint was 1-year MACCE, including all-cause death, cerebrovascular disorder, clinical-driven revascularization, and myocardial infarction.
  • Independent risk factors for MACCE were identified using multivariable analysis.

Main Results:

  • The overall 1-year MACCE rate was 17.5%, with target lesion revascularization (TLR) at 2.0% and cardiac death at 3.4%.
  • Independent risk factors for MACCE included two-stent implantation (HR, 2.49), mechanical cardiac support device use (HR, 2.17), and Canadian Cardiovascular Society (CCS) class ≥ III (HR, 2.07).
  • Radial access (HR, 0.62) and increased left ventricular ejection fraction (HR, 0.72) were associated with reduced MACCE.

Conclusions:

  • Routine imaging-guided LM-PCI is associated with favorable low rates of TLR and cardiac death in real-world practice.
  • Two-stent implantation for LM bifurcation lesions and severe left ventricular dysfunction are associated with increased MACCE risk.
  • These findings highlight the need for comprehensive management strategies in high-risk LM PCI patients.