Routine intracoronary imaging-guided left main coronary intervention

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.