Left Main Coronary Artery Revascularization: Are Periprocedural Complications Significant?

In the field of percutaneous coronary intervention (PCI) and myocardial revascularization surgery (MRS), previous analyses have shown a link between in-hospital and 30-day complications, in terms of complicated progress and/or mortality.

Revascularización del tronco de la coronaria izquierda: ¿son importantes las complicaciones periprocedimiento?

Most of this information comes from non-randomized or old studies, which translates into contradictory data.

Researchers analyzed the EXCEL study, which included patients with severe left main coronary artery lesions who were randomized to PCI (935) or MRS (923).

Non-fatal major adverse event (MAE) rates at 30 days for PCI and MRS were 11.9% vs. 45.4%, respectively (odds ratio [OR]: 0.16; 95% confidence interval [CI]: 0.13-0.21; p < 0.0001). 

The PCI group evidenced lower rates of (protocol-defined) infarction, major and minor bleeding, transfusion (≥2 U), arrhythmia, surgical or radiological procedure, impaired renal function, infection or sepsis, and prolonged intubation compared with the MRS group. Furthermore, stroke, unplanned revascularization, or pericardial syndrome events were infrequent.

These patients, compared with those without MAE, were older and had more comorbidities.

Read also: COAPT: Promising 5-Year Outcomes.

Within 5 years, all-cause mortality occurred in 117 patients in the PCI group and in 87 in the MRS group.

Experiencing MAEs was a strong predictor of 5-year all-cause mortality for both PCI (adjusted OR: 4.61; 95% CI: 2.71-7.82) and MRS (adjusted OR: 3.25; 95% CI: 1.95-5.41). These associations were present within the first 30 days, and between 30 days and 5 years after the procedure.

Major or minor bleeding with need for blood transfusions (≥2 U) was a predictor of 5-year mortality in both procedures.

Read also: TAVR: Vascular Access in Patients with Peripheral Artery Disease, 1-Year Outcomes.

Stroke, unplanned revascularization due to ischemia, and impaired renal function were predictors of mortality only after MRS.

Conclusion

In the EXCEL study, non-fatal periprocedural MAEs were strongly linked to early and late mortality after PCI or MRS for left main disease.

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original: Impact of Periprocedural Adverse Events After PCI and CABG on 5-Year Mortality. The EXCEL Trial.

Reference: Sneha S. Jain, J Am Coll Cardiol Intv 2023;16:303–313.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Andromeda Trial: Meta-Analysis of Drug Coated Balloon vs. DES in Small Vessel DeNovo Lesions

The use of coronary stents vs plain old balloon angioplasty (POBA), has allowed to reduce recoil and limiting flow dissection which were major limitation...

QFR vs. FFR: Is Coronary Revascularization Deferral Safe? Results from a FAVOR III Sub-Analysis

In cases of intermediate coronary lesions, functional assessment is recommended to aid the decision-making process regarding revascularization. There are several tools currently used to...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...