Outcome of Percutaneous Coronary Intervention in Left versus non-left MainCoronary Artery in Acute Coronary Syndrome: A Comparative Study

Abstract

Introduction: Acute coronary syndromes (ACS), particularly those affecting the left main coronary artery (LMCA), are associated with high morbidity and mortality. The objective of the present study was to investigate long-term outcomes in patients who underwent percutaneous coronary intervention (PCI) for ACS affecting the LMCA compared to those with non-LMCA involvement.

Methods: This interventional study was conducted at the Department of Cardiology of M.H. Shamorita Medical College Hospital in Dhaka, Bangladesh, from January 2023 to June 2024, including a number of 101 patients with ACS who underwent PCI (51 in LMCA group and 50 in non-LMCA group). Follow-up assessment was done at 3rd, 6th, and 12th  months, focusing on major adverse cardiovascular events (MACE) as the primary endpoint and persistent symptoms, repeat revascularization and stent thrombosis as secondary endpoints.

Results: The mean age of LMCA and non-LMCA group was 56 and 54 years, respectively, with higher female proportion in LMCA group. The patients in LMCA group presented with more complex lesions, with a mean SYNTAX score of 23.6. The MACE rate was notably higher in the LMCA group at 6% compared to 2% in the non-LMCA group (p=0.013). Myocardial infarction (MI) occurred in 4% of the LMCA group, with no events in the non-LMCA group. Persistent symptoms and repeat revascularization were also more prevalent in the LMCA group (6% and 4%, respectively, p-value <0.05).

Conclusions: Patients with ACS involving the LMCA experienced higher rates of adverse outcomes, particularly MI and repeat revascularization, following PCI compared to non-LMCA cases.

J Inv Clin Cardiol 2024; 6(2): 35-42