Long-term Outcomes after Left Main Coronary Artery Percutaneous Coronary Intervention in Patients Presenting with Acute Coronary Syndrome

Background: Percutaneous Coronary Intervention (PCI) of left main coronary artery (LM) has been a recommended treatment strategy in several stable clinical settings, but evidence is rare in acute coronary syndrome. We aim to evaluate long-term outcomes after LM PCI in patients presenting with ACS.

Methods: 6429 Patients with Acute Coronary Syndrome (ACS) who received interventional treatment in 2013 were enrolled in this study. Patients are divided into Left Main (LM) group and non-Left Main (Non-LM) group according to whether the target lesion was located in LM. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed across 2 groups, including occurrence rates of all-cause death, cardiogenic death, myocardial infarction, revascularization, in-stent thrombosis, stroke and bleeding.

Results: 155 (2.4%) patients have target lesion in LM, while 6274 patients belong to non-LM group. Compared with Non-LM patients, LM patients have higher age (61.91±9.80 vs 58.29±10.41, p<0.001), higher proportion of diabetes (36.1% vs 28.5%, p=0.039)and clinical presentation of unstable angina (77.4% vs 70.0%, p=0.045). 2-year follow-up reveals patients with LM have significantly higher rate of cardiogenic death (2.6% vs 0.7%, p=0.034), myocardial infarction (7.1% vs 1.8%, p<0.001), in-stent thrombosis (4.5% vs 0.8%, p<0.001) and stroke (7.1% vs 6.4%, p=0.025) compared with non-LM patients. After adjusting for confounding factors, LM remains independently associated with higher 2-year myocardial infarction rate (HR 2.532, 95% CI: 1.228-5.222, p=0.012).

Conclusion: In patients presenting with ACS, LM-targeted PCI is associated with multiple 2-year adverse events. LM-targeted PCI is an independent risk factor for 2-year myocardial infarction.