Post-Discharge Major Adverse Events in Patients Surviving Acute Unprotected Left Main Coronary Artery Occlusion

Acute total or subtotal occlusion of the unprotected left main coronary artery (ULMCA) is a rare but severe condition with high short-term mortality. However, the long-term prognosis of patients who survive to discharge after emergent percutaneous coronary intervention (PCI) remains unclear. This study aimed to evaluate long-term clinical outcomes in this population.

This multicenter retrospective study analyzed 61 patients who survived to discharge after emergent PCI for acute total/subtotal ULMCA occlusion. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), including all-cause mortality, target vessel revascularization, heart failure hospitalization, and stroke. Predictors of MACCE were assessed using Cox proportional hazards regression.

The median age of the study cohort was 73 (63-77) years, and 72.1% were male. During a median follow-up of 5.4 (1.0-9.2) years from the date of discharge, MACCE occurred in 38 patients (62.3%). The MACCE rates at 5 and 10 years were 58.6% and 74.6%, respectively. The corresponding all-cause mortality rates were 33.5% and 47.4%. Cardiac death was observed in eight patients (13.1%), while 14 patients (23.0%) died from noncardiac causes. Among the clinical and procedural factors assessed, only intratracheal intubation at presentation was identified as an independent predictor of MACCE (adjusted hazard ratio: 2.15, 95% confidence interval: 1.10-4.24, p = 0.03).

These findings suggest the importance of post-discharge management strategies for patients who underwent emergent PCI for acute total/subtotal ULMCA occlusion due to the persistent risk of cardiac or cerebrovascular events.