PERCUTANEOUS CORONARY INTERVENTION FOR LEFT MAIN DISEASE IN HIGH BLEEDING RISK: OUTCOMES FROM A SUBANALYSIS OF THE DELTA 2 REGISTRY

High bleeding risk (HBR) can represent a challenge, especially in patients with complex coronary lesions undergoing PCI. This study aims at investigating the prevalence of HBR in a wide and comprehensive cohort of patients undergoing left main (LM) PCI, describing their clinical phenotype, and reporting their procedural outcomes.

The analysis was performed on data from the DELTA 2 Registry, which prospectively included patients who underwent LM PCI at 19 centers worldwide. The patients were defined to be at HBR if ≥1 Major Criteria or ≥2 Minor Criteria from the Academic Research Consortium (ARC) were met. The primary endpoint was a composite of all–cause death, myocardial infarction (MI) or stroke at median follow–up.

A total of 1531 patients were included, the rate of HBR was 65.8%. Besides the different clinical characteristics embedded in the ARC definition, HBR had higher prevalence of ACS at presentation (49.2% vs 26.8%, p<0.001), and experienced higher in hospital mortality (1.8% vs 0.2%; p=0.029) and MI (5.0% vs 2.1%, p=0.009) (Figure, Panel A). The median follow–up was 473 days. The rate of the primary endpoint was more than three times higher in HBR patients (20.8% vs 6.1%; HR 3.3; 95% CI: 2.2–4.8) (Figure, Panel B), and significantly driven by all cause death (16.2% vs 4.6%; HR: 3.3; 95% CI:2.2–5.1) and MI (5.8% vs 1.9%; HR 2.9; 95% CI: 1.5–5.7). Conversely no significant difference was reported in terms of target lesion revascularization (TLR) probable or defined stent thrombosis.

HBR patients undergoing LM PCI experienced higher rates of all cause death and MI at follow–up; similar outcomes were also reported in–hospital.