Percutaneous coronary intervention for left main coronary artery. Temporal trends and long-term outcomes from the all-comers BIA-LM registry.

Abstract

Background: Percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) was endorsed by trials.

Aims: Aim was to assess prognosis and temporal trends in real-world registry.

Methods: 998 patients undergoing LMCA PCI were hospitalized from 12.27.2007 to 02.21.2022. Analysis included mortality predictors, annual and periodic trends (2007-2015 compared to 2015-2022).

Results: Median age was 71 years (IQR 16), 736 (73.8%) were male and 448 (51.9%) had multimorbidity (≥3 chronic diseases). Worse prognosis was associated with age ≥75 years (HR 1.61, 95% CI 1.17-2.20, P=0.003), myocardial infarction (HR 1.47, 95% 1.06-2.04, P=0.02), previous myocardial infarction (HR 1.43, 95% CI 1.07-1.91, P=0.02), diabetes (HR 1.38, 95% CI 1.03-1.84, P=0.03), atrial fibrillation (HR 1.74, 95% CI 1.26-2.39, P=0.001), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.27-3.20, P=0.003) and previous stroke (HR 1.78, 95% CI 1.17-2.70, P=0.007). Higher ejection fraction (HR 0.98, 95% CI 0.96-0.99, P<0.001 for 1% increase) and intravascular imaging (HR 0.70, 95% CI 0.49-1.00, P=0.047) yielded better outcomes. Rate of LMCA PCI emerged from 2.2% in 2008 to 6.9% in 2021 (P<0.001). There were increases in annual and periodic rates of multimorbidity (P<0.001), intravascular imaging (P<0.001) and decreases in 30-, 90-day (log-rank P<0.001) and 1-year mortality (log-rank P=0.007). Six-year landmark mortality analysis at 30-days showed trend toward worse prognosis in patients hospitalized in late period (log-rank P=0.051).

Conclusions: PCI and multimorbidity rates increased. Short-term mortality decreased, while prognosis beyond 30-days worsened. Advancements in PCI technology may improve early outcomes; however, efforts should be made to reduce burden of multimorbidity.