Long-Term Outcome of Left Main Percutaneous Coronary Intervention in Patients with Coronary Artery Disease

  • A. Marushko Clinic for adult patients of Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
  • G. Mankovsky Clinic for adult patients of Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
  • Ye. Marushko Clinic for adult patients of Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
  • S. Kuzmenko Clinic for adult patients of Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
  • N. Rudenko Clinic for adult patients of Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
Keywords: left main lesion, stenting


At the present time, left main (LM) stenting is an alternative to coronary artery bypass grafting in patients with coronary artery disease (CAD) and haemodynamically significant LM lesion. Despite of long history of LM interventions, long-term results are still poorly understood. Presented data are still conflicting and need further affirmation.

Aim. To investigate long-term outcomes of percutaneous coronary intervention (PCI) in patients with LM lesions.

Materials and methods. The study included 27 patients with CAD with haemodynamically significant LM lesion who underwent PCI. The risk was calculated using the SYNTAX Score and the SYNTAX Score II in all the patients. According to the results of the calculation, patients were divided into 3 groups: the low risk group (SYNTAX Score = 0-22) included 16 (59.3%) patients, the medium risk group (SYNTAX Score = 23-32) included 8 (29.6%) patients, and the high-risk group (SYNTAX Score > 32) included 3 (11.1%) patients.

Results. The incidence of major adverse cardiovascular events during the mean follow-up period of 30.9 months was 11.1%, while 89.9% of patients had good immediate and long-term results of the procedure. Fatal cases were reported only in groups of patients with intermediate and high risk according to evaluation by the SYNTAX score. No fatal cases were observed in low risk group of patients according to the SYNTAX score. Thus, patient affiliation with one of the risk groups based on the SYNTAX Score scale affected the long-term LM PCI outcomes.

Conclusions. In patients with LM lesion, PCI can be performed with good long-term results in 89.9% of cases. The main criterion for the selection of patients for LM PCI is the risk calculation data based on the SYNTAX Score scale, taking into account the decision of the Heart Team.


  1. Ragosta M, Dee S, Sarembock IJ, Lipson LC, Gimple LW, Powers ER. Prevalence of unfavorable angiographic characteristics for percutaneous intervention in patients with unprotected left main coronary artery disease. Catheter Cardiovasc Interv. 2006 Sep;68(3):357–62. https://doi.org/10.1002/ccd.20709
  2. Taggart DP, Kaul S, Boden WE, Ferguson TB Jr, Guyton RA, Mack MJ, et al. Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery. J Am Coll Cardiol. 2008 Mar 4;51(9):885–92. https://doi.org/10.1016/j.jacc.2007.09.067
  3. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009 Mar 5;360(10):961–72. https://doi.org/10.1056/NEJMoa0804626
  4. Higami H, Toyofuku M, Morimoto T, Ohya M, Fuku Y, Yamaji K, et al. Acute Coronary Syndrome With Unprotected Left Main Coronary Artery Culprit – An Observation From the AOI-LMCA Registry. Circ J. 2018 Dec 25;83(1):198–208. https://doi.org/10.1253/circj.CJ-18-0896
  5. Sadowski M, Gutkowski W, Raczynski G, Janion-Sadowska A, Gierlotka M, Polonski L. Acute myocardial infarction due to left main coronary artery disease in men and women: does ST-segment elevation matter? Arch Med Sci. 2015 Dec 10;11(6):1197–204. https://doi.org/10.5114/aoms.2015.56345
  6. Taylor HA, Deumite NJ, Chaitman BR, Davis KB, Killip T, Rogers WJ. Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry. Circulation. 1989 Jun;79(6):1171–9. https://doi.org/10.1161/01.cir.79.6.1171
  7. Cohen MV, Gorlin R. Main left coronary artery disease. Clinical experience from 1964-1974. Circulation. 1975 Aug;52(2):275–85. https://doi.org/10.1161/01.cir.52.2.275
  8. Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994 Aug 27;344(8922):563–70. https://doi.org/10.1016/s0140-6736(94)91963-1
  9. Wykrzykowska JJ, Garg S, Girasis C, de Vries T, Morel MA, van Es GA, et al. Value of the SYNTAX score for risk assessment in the all-comers population of the randomized multicenter LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial. J Am Coll Cardiol. 2010 Jul 20;56(4):272–7. https://doi.org/10.1016/j.jacc.2010.03.044
  10. Campos CM, Garcia-Garcia HM, van Klaveren D, Ishibashi Y, Cho YK, Valgimigli M, et al. Validity of SYNTAX score II for risk stratification of percutaneous coronary interventions: A patient-level pooled analysis of 5,433 patients enrolled in contemporary coronary stent trials. Int J Cardiol. 2015;187:111–5. https://doi.org/10.1016/j.ijcard.2015.03.248
  11. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Jan 7;40(2):87–165. https://doi.org/10.1093/eurheartj/ehy394
  12. Park DW, Ahn JM, Park SJ, Taggart DP. Percutaneous coronary intervention in left main disease: SYNTAX, PRECOMBAT, EXCEL and NOBLE-combined cardiology and cardiac surgery perspective. Ann Cardiothorac Surg. 2018 Jul;7(4):521–6. https://doi.org/10.21037/acs.2018.04.04
  13. Stone GW, Sabik JF, Serruys PW, Simonton CA, Genereux P, Puskas J, et al. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med 2016;375:2223–35. https://doi.org/10.1056/NEJMoa1610227
  14. Makikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet. 2016 Dec 3;388(10061):2743–52. https://doi.org/10.1016/S0140-6736(16)32052-9
How to Cite
Marushko, A., Mankovsky, G., Marushko, Y., Kuzmenko, S., & Rudenko, N. (2020). Long-Term Outcome of Left Main Percutaneous Coronary Intervention in Patients with Coronary Artery Disease. Ukrainian Journal of Cardiovascular Surgery, (1 (38), 13-18. https://doi.org/10.30702/ujcvs/20.3803/017013-018