Long-Term Data Shows High In-Hospital Mortality with PCI in LMCA Disease

A study presented at the Transcatheter Cardiovascular Therapeutics (TCT) 2021 Annual Meeting investigated long-term clinical outcomes of percutaneous coronary intervention (PCI) in the left main coronary artery (LMCA) disease.

PCI for LMCA Disease

“LMCA acute occlusion is uncommon (0.8% of primary PCI) with very poor prognosis,” wrote the study authors. “In this situation, primary PCI is a complex procedure with a high mortality because of hemodynamic and electrical instability of patients.”

In this study, the researchers assessed 14 years of follow-up from 58 prospectively enrolled patients treated between 2006 and 2020 at the University General Hospital of Ciudad Real, Spain. Patients were aged an average of 66.8 years and the cohort was 77.6% male. The primary outcome was incidence of major adverse cardiac events (MACE), defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization (TLR), and stent thrombosis.

The most common LMCA bifurcation technique used was “provisional stenting,” in 81.8% of cases, and final “Kissing balloon” techniques were used in 55.2% of procedures.

Long-Term MACE Incidence

The rate of MACE at 14 years was 25.9%. The rate of cardiac death was 20.7%, and the rate of in-hospital mortality was 13.8%. The researchers noted that patients with moderate-to-severe left ventricular systolic dysfunction (P=0.007) and those with Killip class ≥3 at presentation (P=0.004) had a significantly higher incidence of MACEs compared with patients without these attributes. Overall, 24.2% of patients had an angiographic follow-up.

In conclusion, the authors wrote, “Primary PCI in LMCA disease presents high in-hospital mortality despite high angiographic success rate without complications at the procedure. Those patients who get to be discharged from the hospital have very favorable results with a low rate of major cardiac events at very long-term follow-up.”

Reference: Concepcion-Suarez R, et al. TCT 331: Percutaneous coronary intervention in left main coronary artery disease concomitant with acute coronary syndrome. Clinical outcomes at a long-term follow-up. Presented at TCT 2021, Orlando, FL, Nov. 4–6, 2021.