Impact of lesion location and SYNTAX score breakdown on patients undergoing percutaneous left main revascularization

Left main coronary artery disease (LMCAD) complexity is assessed using the SYNTAX score. High scores may reflect complex LM lesions or multivessel disease. Evidence on the prognosis of these distinct populations is scarce.

Patients undergoing percutaneous coronary intervention (PCI) for unprotected LMCAD were categorized into four groups based on LM lesion location (Body/Ostial vs. Bifurcation) and non-LM SYNTAX score (≤8 vs. >8). The reference group was Body/Ostial cases with low non-LM score. The primary endpoint was Major Adverse Cardiac Events (MACE), composite of death, myocardial infarction, or target vessel revascularization (TVR) at 1 year.

Out of 869 patients undergoing LM PCI, 69.2 % had a LM bifurcation lesion, and 44.8 % non-LM SYNTAX score >8. Patients with high non-LM score (>8) were older, had higher rates of chronic kidney disease, and were more likely to present with congestive heart failure or low ejection fraction. After adjustment, both groups with LM bifurcation disease had higher rates of 1-year MACE, driven by TVR. In contrast, there was no difference between the Body/Ostial lesion with high non-LM score group and the reference group.

Amongst patients undergoing LM PCI, those with LM bifurcation lesions are more likely to require repeat revascularization, regardless of non-LM SYNTAX score. Lesion complexity should be considered separately from the number of lesions.