Five-year outcomes after left main PCI stratified by procedural urgency

Left main coronary artery (LMCA) disease is found in a considerable percentage of patients undergoing diagnostic coronary angiography and is associated with high morbidity and mortality due to the large myocardial territory at risk. Although coronary artery bypass grafting (CABG) remains the reference treatment, advances in percutaneous coronary intervention (PCI) have established it as a suitable option in selected cases. Evidence comparing outcomes according to procedural urgency is scarce, as most studies excluded acute presentations. This analysis aimed to assess five-year outcomes after LMCA PCI stratified by procedural urgency in a single-centre cohort.

This study aimed to evaluate five-year clinical outcomes after left main percutaneous coronary intervention (PCI), comparing elective versus urgent/emergent procedures in a single-centre cohort, and to determine whether procedural urgency influences mortality or myocardial infarction during follow-up.

A retrospective observational study was performed as part of a single-centre subanalysis of the Left Main Revascularisation Registry. A total of 89 patients who underwent left main PCI between 2017 and 2022 were included, of whom 45 had elective and 44 urgent/emergent procedures. Clinical characteristics were obtained from electronic medical records, and follow up was performed through both medical records and telephone calls. Events considered included all-cause mortality and acute myocardial infarction (AMI), both during hospitalization and in follow-up. An adjusted Cox model was used to compare events between groups, employing the likelihood ratio test. A p-value < 0.05 was considered statistically significant. All calculations were performed using R version 4.3.0.

Patients in the urgent/emergent group were younger (60 [52–65] vs. 65 [57–75] years, p=0.037) and had a higher prevalence of three-vessel disease (56.8% vs. 35.6%). No significant differences were found in ejection fraction, diabetes, or renal disease. At five-year follow-up, all-cause mortality was 11% in the urgent/emergent group and 18% in the elective group (p=0.4). The incidence of myocardial infarction was 14% versus 6.7%, respectively (p=0.3). Kaplan–Meier analysis showed no significant differences in survival or infarction rates between groups.

In this single-centre cohort, procedural urgency did not significantly influence long-term mortality or myocardial infarction after left main PCI. These findings suggest comparable five-year outcomes between elective and urgent/emergent interventions, supporting PCI as a feasible strategy across different clinical presentations.

All-cause mortality curve