Stoler Robert C, Jeong Minseob, Akram Talha, Monhollen Alec, Vazquez David Fernandez, Mamawala Mufaddal, Witt Trenton A, Bruneman Blake, Weideman Sarah, Adelman Kennedy S, Sharma Shalini, Furqan Yumna, Rosol Zachary P, Rengarajan Ronak, Schussler Jeffrey M, Vallabhan Ravi C, Chugh Yashasvi, Yoon Dong-Hi Anthony, Feghali Georges A, Velasco Carlos E, Sayfo Sameh, Al-Azizi Karim M, Mixon Timothy A, Widmer Robert J, Potluri Srinivasa P, Banerjee Subhash
Baylor Heart and Vascular Hospital, Dallas, Texas; Baylor University Medical Center, Dallas, Texas.
Baylor Heart and Vascular Hospital, Dallas, Texas; Baylor Scott & White Research Institute, Dallas, Texas.
Am J Cardiol. 2025 Apr 15;241:17-25. doi: 10.1016/j.amjcard.2025.01.008. Epub 2025 Jan 20.
There are limited comparative data on real-world outcomes of patients undergoing percutaneous coronary intervention (PCI) of the left main (LM) and non-LM coronary arteries.
Total 873 consecutive patients undergoing LM PCI (n = 256) and non-LM PCI (n = 617) were enrolled between September 2019-March 2023 in the Excellence in Coronary Artery Disease (XLCAD) Registry. Primary outcome was 1-year incidence of major adverse cardiovascular events (MACE), a composite of all-cause death, nonfatal myocardial infarction, clinically driven repeat revascularization and ischemic stroke. The secondary outcome was periprocedural (≤30 days) events.
Study cohort included 68% men, mean age 71.9 ± 10.3 in LM and 67.2 ± 11.1 years in non-LM PCI groups (p <0.001). LM PCI patients had significantly greater co-morbidities (diabetes mellitus, hyperlipidemia, prior stroke, prior myocardial infarction, prior coronary revascularization, peripheral artery disease, chronic lung and kidney disease and heart failure) compared with non-LM. Acute coronary syndrome indication was the most prevalent (69%). Mechanical circulatory support was employed in 3.1% LM vs 1% non-LM PCI patients (p = 0.026). Mean number of lesions treated were 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% LM and 21% non-LM PCI patients (p <0.001). Overall, drug-eluting stent use (96.7%), bifurcation PCI (24.7%) and atherectomy (2.4%) were similar across groups. Technical and procedural success rates were high across groups, however significantly higher in non-LM group. Periprocedural (≤30 days postprocedure) events included mortality in 3.5% LM and 1.5% non-LM PCI (p = 0.334) and MACE 4.7% LM vs 2.4% non-LM PCI (p = 0.080) groups. One-year MACE was significantly higher in LM versus non-LM PCI (12.9% vs 8.4%, respectively; p = 0.043), driven mainly by higher repeat percutaneous revascularization in LM group (12.1% vs 6.2%; p = 0.003). Mortality at 1-year in LM vs non-LM PCI were 10.2% vs 5.8% (p = 0.074).
In a real-world experience, LM PCI is performed in patients with significantly greater comorbidities compared with non-LM PCI, with high procedural success. Thirty-day mortality and 1-year MACE are significantly higher in LM group.
关于接受经皮冠状动脉介入治疗（PCI）的左主干（LM）和非左主干冠状动脉患者的真实世界预后的比较数据有限。
2019年9月至2023年3月期间，共有873例连续接受LM PCI（n = 256）和非LM PCI（n = 617）的患者被纳入冠状动脉疾病卓越（XLCAD）注册研究。主要结局是1年主要不良心血管事件（MACE）发生率，MACE是全因死亡、非致命性心肌梗死、临床驱动的再次血运重建和缺血性卒中的复合终点。次要结局是围手术期（≤30天）事件。
研究队列中男性占68%，LM PCI组的平均年龄为71.9±10.3岁，非LM PCI组为67.2±11.1岁（p<0.001）。与非LM患者相比，LM PCI患者的合并症（糖尿病、高脂血症、既往卒中、既往心肌梗死、既往冠状动脉血运重建、外周动脉疾病、慢性肺和肾脏疾病以及心力衰竭）明显更多。急性冠状动脉综合征是最常见的适应证（69%）。3.1%的LM PCI患者和1%的非LM PCI患者使用了机械循环支持（p = 0.026）。LM PCI组平均治疗病变数为2.2±1.0个，非LM PCI组为1.4±0.6个（p<0.001）。68.8%的LM PCI患者和21%的非LM PCI患者接受了多支血管PCI（p<0.001）。总体而言，各组间药物洗脱支架的使用（96.7%）、分叉病变PCI（24.7%）和旋切术（2.4%）相似。各组的技术成功率和手术成功率都很高，但非LM组明显更高。围手术期（术后≤30天）事件包括3.5%的LM PCI患者和1.5%的非LM PCI患者死亡（p = 0.334），MACE在LM PCI组为4.7%，非LM PCI组为2.4%（p = 0.080）。LM PCI组的1年MACE明显高于非LM PCI组（分别为12.9%和8.4%；p = 0.043），主要原因是LM组再次经皮血运重建率较高（12.1%对6.2%；p = 0.003）。LM PCI组和非LM PCI组的1年死亡率分别为10.2%和5.8%（p = 0.074）。
在真实世界经验中，与非LM PCI相比，接受LM PCI的患者合并症明显更多，但手术成功率较高。LM组30天死亡率和1年MACE明显更高。
