Impact of Interventional Strategy for Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention on Long-term Survival

Abstract Background Percutaneous coronary intervention (PCI) of unprotected left main coronary artery (ULMCA) is feasible. In cases involving the left anterior descending–left circumflex bifurcation, the optimal interventional strategy remains unclear. Randomized bifurcation trials in the past excluded ULMCA lesions. Methods A single-centre registry study with retrospective analysis of the interventional protocols and procedural angiograms of 102 patients who underwent stent PCI of ULMCA was performed in order to evaluate the impact of the interventional strategy on long-term survival. Results Isolated stenting of the ostium or mid ULMCA without bifurcation stenting was performed in 19 patients. Most interventions (n = 83) involved the left main bifurcation. Distal or bifurcation lesions were treated by provisional T-stenting in cases of single involved ostium (left anterior descending or right circumflex) or systematic T-stenting or V-stenting if both proximal coronary arteries were involved (n = 19). The majority (96%) of patients received drug-eluting stents. The long-term survival (mean follow-up = 3.4 ± 1.7 years) of patients was influenced by the interventional strategy. A single-stent strategy involving the bifurcation without side branch intervention was associated with less-favourable long-term survival (hazard ratio 4.08; 95% confidence interval, 1.91-8.69; multivariable Cox regression analysis). Conclusions This prospective observational study suggests that single-stent PCI involving the bifurcation without side branch intervention of ULMCA is possibly associated with higher long-term mortality. ULMCA-PCI involving the bifurcation is possible with similar results compared with isolated PCI of ULMCA shaft or ostium. Large, randomized trials are warranted for comparison of optimal technical approach to LMCA interventions.