Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Early and Long-term Outcomes of Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention to the Left Main Coronary Artery,” published in the December 2024 issue of Cardiology by Abdelghani et al.  

People with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) to unprotected left main (LM) coronary arteries have not been sufficiently studied with modern PCI techniques.  

Researchers conducted a prospective study investigating early and long-term outcomes of people undergoing PCI to the LM artery in ACS.  

They used the Left Main Intervention in Acute Coronary Syndrome (LIMACS) registry, enrolling 360 people with ACS undergoing PCI to unprotected LM disease using drug-eluting stents. In-hospital mortality, 3-year mortality, and significant adverse outcomes were assessed with factors such as cardiogenic shock, left ventricular ejection fraction (LVEF), and final Thrombolysis in Myocardial Infarction (TIMI) grade flow.  

The results showed that 25% of people developed cardiogenic shock, and 15% died during hospitalization. Factors associated with in-hospital mortality included cardiogenic shock (adjOR: 26 [7-93]) and final TIMI grade <3 Flow (adjOR: 7 [1.6-31]), 3-year mortality (37%) was linked to LVEF ≤40% (adjHR]: 2.4 [1.4-4.2]), Killip class II-IV at presentation (adjHR: 1.7 [1.02-2.8]), LM culprit lesion (adjHR: 1.7 [1.04-2.8]), true LM bifurcation stenosis (adjHR: 1.8 [1.1-2.9]), final TIMI grade <3 Flow (adjHR: 3.2 [1.7-5.8]), and radial access (adjHR: 0.58 [0.38-0.99]). In people with true LM bifurcation stenosis (n=127), a 2-stent strategy was used in 60% of cases and associated with lower 3-year mortality or repeat revascularization (48% vs. 69%, P=0.012).  

They concluded that PCI to the LM artery in ACS carried a high risk of adverse outcomes, with factors like hemodynamic status, femoral access, and restoration of normal flow being critical to people’s survival.  

Source: ajconline.org/article/S0002-9149(24)00844-0/abstract