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The following is a summary of “Comparative Outcomes of Left Main and Nonleft Main Percutaneous Coronary Intervention from the Excellence in Coronary Artery Disease (XLCAD) Registry,” published in the January 2025 issue of American Journal of Cardiology by Stoler et al. 

Researchers conducted a retrospective study on real-world outcomes of percutaneous coronary intervention (PCI) in left main (LM) and non-LM coronary arteries.  

They enrolled 873 patients undergoing PCI (LM: 256, non-LM: 617) from September 2019 to March 2023 in the Excellence in Coronary Artery Disease (XLCAD) Registry. They assessed 1-year major adverse cardiovascular events (MACE) (death, nonfatal myocardial infarction (MI), revascularization, stroke) as the primary outcome and ≤30-day events as the secondary outcome. 

The results showed that 68% were men, with a mean age of 71.9 ± 10.3 in LM and 67.2 ± 11.1 in non-LM PCI (P <0.001). Patients with LM PCI had more comorbidities. Acute coronary syndrome was the most common (69%). Mechanical circulatory support was used in 3.1% LM vs 1% non-LM PCI (P = 0.026). The mean lesions treated were 2.2 ± 1.0 in LM and 1.4 ± 0.6 in non-LM PCI (P <0.001). Multivessel PCI was performed in 68.8% LM vs 21% non-LM PCI (P <0.001). Drug-eluting stent use (96.7%), bifurcation PCI (24.7%), and atherectomy (2.4%) were similar. Procedural success was higher in non-LM PCI. Periprocedural mortality was 3.5% LM vs 1.5% non-LM PCI (P = 0.334), and MACE was 4.7% LM vs 2.4% non-LM PCI (P = 0.080). One-year MACE was 12.9% LM vs 8.4% non-LM PCI (P = 0.043), driven by repeat PCI (12.1% vs 6.2%; P = 0.003). About 1-year mortality was 10.2% LM vs 5.8% non-LM PCI (P = 0.074). 

Investigators performed LM PCI in patients with more comorbidities and high procedural success. The LM group had higher 30-day mortality and 1-year MACE. 

Source: ajconline.org/article/S0002-9149(25)00029-3/abstract