Percutaneous Coronary Intervention for Severe Left Main Coronary Disease: National 3-Year Data-Linkage Study

Background: Approximately 5% of patients undergoing coronary angiography have left main coronary disease (LMS) with >50% stenosis. Recent randomised trials have shown that percutaneous coronary intervention (PCI) has comparable outcomes to coronary artery bypass grafting (CABG), particularly in those with low or intermediate risk, although in practice, PCI is frequently utilised in those with prohibitive surgical risk. This study reviewed the contemporary national characteristics and outcomes of PCI for severe LMS disease. Methods: All patients who underwent PCI for LMS disease >50% from 1 September 2014 to 24 September 2017 were extracted from the All New Zealand Acute Coronary Syndrome-Quality Improvement (ANZACS-QI) registry program and linked with national datasets; characteristics, and in-hospital outcomes were analysed. Results: There were 469 patients during the study period, with mean age 70.8 ± 10.7 years, male 331 (71%), and the majority 339 (72%) were unprotected LMS. Indications included 83 (18%) with ST-elevation myocardial infarction (STEMI), 229 (49%) with Non-STEMI or unstable angina, and radial access was used in 364 (78%). In-hospital outcomes include death in 37 (7.9%, higher for unprotected than protected LMS 9.4 vs 3.9%; p = 0.045), recurrent MI in 11 (2.4%), stroke in two (0.4%), and stent thrombosis, vascular complication and emergency CABG in three (0.6%) each. Independent predictors of in-hospital composite cardiovascular events and death included STEMI indication, femoral access, and worse renal function. Conclusion: Percutaneous coronary intervention was a high-risk procedure for treating severe left main disease in this cohort, with in-hospital mortality of 7.9%. It has important predictors of STEMI indication, femoral access, and worse renal function, but remains a viable alternative to CABG in this setting.