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

Researchers conducted a retrospective study to compare real-world outcomes of patients undergoing percutaneous coronary intervention (PCI) for left main (LM) and non-left main (non-LM) coronary arteries.  

They enrolled 873 consecutive patients from the Excellence in Coronary Artery Disease (XLCAD) Registry, with 256 undergoing LM PCI and 617 undergoing non-LM PCI between September 2019 and March 2023. The primary outcome was the 1-year incidence of major adverse cardiovascular events (MACE), which included all-cause death, non-fatal myocardial infarction, clinically driven repeat revascularization, and ischemic stroke, and the secondary outcome was periprocedural (≤30 days) events.  

The results showed 68% of the cohort were men, with a mean age of 71.9 ± 10.3 years in the LM PCI group and 67.2 ± 11.1 years in the non-LM PCI group (P <0.001). The patients with LM PCI had more comorbidities, including diabetes mellitus, hyperlipidemia, prior stroke, myocardial infarction, coronary revascularization, peripheral artery disease, chronic lung and kidney disease, and heart failure. Acute coronary syndrome was the most common indication (69%). Mechanical circulatory support was used in 3.1% of LM and 1% of non-LM PCI patients (P =0.026). The mean number of lesions treated was 2.2 ± 1.0 in LM and 1.4 ± 0.6 in non-LM PCI groups (P <0.001). Multivessel PCI was performed in 68.8% of LM and 21% of non-LM PCI patients (P <0.001). Drug-eluting stent use (96.7%), bifurcation PCI (24.7%), and atherectomy (2.4%) were similar across groups. Technical and procedural success rates were higher in the non-LM group. Periprocedural mortality was 3.5% in LM and 1.5% in non-LM PCI (P =0.334), and MACE occurred in 4.7% of LM and 2.4% of the patients of non-LM PCI (P =0.080), 1-year MACE was significantly higher in LM PCI (12.9% vs 8.4%, P =0.043), mainly due to higher repeat percutaneous revascularization in the LM group (12.1% vs 6.2%, P =0.003). Mortality at 1-year was 10.2% in LM and 5.8% in non-LM PCI (P =0.074).  

Investigators concluded that in a real-world setting, LM PCI was performed in patients with more comorbidities than non-LM PCI despite achieving high procedural success while demonstrating significantly higher 30-day mortality and 1-year MACE rates compared to the non-LM group. 

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