Long-term survival after percutaneous coronary intervention to unprotected left main coronary artery (LMPCI) in the absence of ST-elevation MI (STEMI) or cardiogenic shock (CS).

Abstract

Introduction: Current evidence suggests unprotected left main percutaneous coronary intervention (LMPCI) in selected stable or pain-free patients is a safe alternative to coronary artery bypass. However, long-term survival data in the real world are limited. Methods: We analysed 24,644 consecutive patients from the MIG (Melbourne Interventional Group) registry enrolled from 2005 to 2020. We compared baseline clinical and procedural characteristics, in-hospital and 30-day outcomes, and long-term survival in those undergoing LMPCI (n=185, 0.8%) versus non-LMPCI (n=24,459). Results: LMPCI patients were significantly older, had more left ventricular dysfunction and renal impairment, and had higher rates of IVUS (21% vs 1%) and drug-eluting stent use (p<0.001). LMPCI had longer hospital stay compared to non-LMPCI, but there was no significant difference in other in-hospital outcomes, 30-day mortality (0.6% vs 0.6%, p=0.90) or major adverse cardiac events (1.7% vs 3%, p=0.28). Kaplan-Meier survival to eight years was similar with LMPCI versus non-LMPCI. LMPCI was not a predictor of long-term survival after Cox regression analysis. Conclusions: Unprotected LMPCI in patients without STEMI or CS is uncommonly performed, and IVUS is underutilised. However, there is comparable 30-day outcomes and long-term survival compared to non-LMPCI.