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.


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.

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