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

Abstract

Background: Percutaneous coronary intervention (PCI) for the left main coronary artery (LMCA) was endorsed by trials. Aims: This article aimed to assess prognosis and temporal trends in a real-world registry. Methods: In total, 998 patients undergoing LMCA PCI were hospitalized from December 27, 2007 to February 21, 2022. The analysis included mortality predictors, annual and periodic trends assessments (2007–2015 compared to 2015–2022). Results: The median age of patients was 71 years (interquartile range 16); 736 (73.8%) were male, and 448 (51.9%) had multimorbidity (≥3 chronic diseases). Worse prognosis was associated with age ≥75 years (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.17–2.20; P= 0.003), myocardial infarction (HR, 1.47; 95% CI, 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. The rate of LMCA PCI increased from 2.2% in 2008 to 6.9% in 2021 (P <0.001). There were increases in annual and periodic multimorbidity rates (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 a trend toward worse prognosis in patients hospitalized in the 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 multimorbidity burden.