Courtesy of Dr. Juan Manuel Pérez.
Unprotected left main (ULM) percutaneous coronary intervention (PCI) remains associated with a high risk of adverse events, even with the use of second-generation drug-eluting stents and optimal medical therapy. Post-procedural follow-up is usually symptom-driven, but the usefulness of a systematic coronary CT angiography (CCTA)-based surveillance strategy had not been evaluated in a randomized trial.
The PULSE study was a multicenter, randomized, open-label clinical trial designed to compare routine CCTA follow-up at 6 months versus standard symptom/ischemia-guided follow-up. Hospitalized patients with chronic or acute coronary syndrome and an indication for ULM PCI were included.
Between October 2019 and September 2023, a total of 606 patients were enrolled. Of these, 84% presented with acute coronary syndrome. Intracoronary imaging was used in 70% of procedures, and 80% had distal ULM lesions. A total of 303 patients were assigned to planned CCTA at 6 months, and 303 to standard follow-up.
The primary endpoint (MACE: all-cause death, spontaneous myocardial infarction, unstable angina, or stent thrombosis at 18 months) occurred in 12.5% of the CCTA group and 11.9% of the control group (HR 0.97; 95% CI 0.76–1.23), with no significant differences. In secondary analyses, spontaneous myocardial infarction was less frequent in the CCTA group (0.9% vs 4.9%; HR 0.24; 95% CI 0.07–0.84; p=0.025), at the expense of a higher number of revascularizations triggered by imaging findings. No differences in mortality were observed (HR 0.78; 95% CI 0.49–1.25; p=0.30).
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The authors concluded that routine CCTA at 6 months after ULM PCI did not reduce the composite endpoint of MACE at 18 months. However, a significant reduction in spontaneous myocardial infarction was observed, albeit accompanied by a higher frequency of imaging-driven revascularizations.
Reference: De Filippo O. et al. en Major Late Breaking Trials, ESC 2025, Madrid, España.
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