Left Main Coronary Artery Percutaneous Coronary Intervention: Evolution and Results over Time

Left main coronary artery percutaneous coronary intervention (LMCA PCI) is a treatment option that is increasingly used in our setting. One of the reasons for choosing this therapeutic strategy is the improvements in devices and techniques. However, the long-term results of LMCA PCI are not well established.

Angioplastia al tronco de la coronaria izquierda: evolución y resultados en el tiempo

The aim of this retrospective study was to analyze UK data to assess the time trend of LMCA PCI and its clinical outcomes over a 9-year period.

Researchers analyzed 14,522 patients who underwent LMCA PCI between 2009 and 2017 in the UK. Changes in patient demographics were observed, with patients being older and with greater comorbidities. In addition, procedural complexity increased, either with greater number of vessels treated, bifurcation involvement, or greater number of stents used, and greater use of intravascular ultrasound and rotational atherectomy.

After adjustment, there was a significant reduction in the time to occurrence of periprocedural acute myocardial infarction (p < 0.001), in-hospital major cardiac or cerebrovascular events (p < 0.001), and procedural complications (p < 0.001).

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In a multivariate analysis, age, female sex, number of stents, and patient comorbidity were associated with higher rates of in-hospital cardiac or cerebrovascular events. Meanwhile, use intravascular imaging and year of PCI were associated with lower rates of major in-hospital events.

Conclusion

In patients with LMCA PCI, there were significant temporal changes with the increase in age and comorbidities. While the complexity of this intervention increases over the years, the rate of periprocedural acute myocardial infarction, major in-hospital events, and procedural complications decrease significantly over time. This information is of great help to the Heart Time when it comes to decision making regarding choosing a therapeutic strategy.