Percutaneous coronary intervention of unprotected left main coronary artery in the emergent/urgent setting

BACKGROUND: Treatment of unprotected left main coronary disease by percutaneous interventions, even in the urgent setting, is still not an approved indication. However, the evolution of transcatheter technology and supporting devices, along with greater skill in high-volume centers, led the interventional community to deal with these cases. This study aimed to investigate whether the percutaneous approach in this cohort could be a viable alternative to coronary artery bypass graft (CABG) surgery in the urgent setting. METHODS: We enrolled 51 acute myocardial infarction patients with left main disease as the culprit lesion and treated them by percutaneous coronary intervention. This cohort was followed for major adverse cardiac and cerebrovascular events (MACCE) in-hospital and at 30 days, 6 months and 1 year, and was compared with a population of 35 CABG patients matched for clinical and angiographic characteristics. RESULTS: The estimated MACCE-free survival at 6 months and 1 year was 90% and 88%, respectively. The overall MACCE was 6%. Analysis of the surgical cohort showed an overall MACCE of 17%. In the final Cox model, significant predictors of MACCE were Parsonnet score for surgical risk (HR 1.93, 95% CI 1.15 - 7.3; p ≤ 0.04) and diabetes mellitus (HR 1.73, 95% CI 1.03 - 3.8; p ≤ 0.038). CONCLUSIONS: Angioplasty for unprotected left main coronary disease in the urgent clinical setting is feasible, showing a relatively low short- and long-term rate of MACCE.