Background

Left Main Coronary Artery (LMCA) disease is associated with substantial morbidity and mortality because it supplies a large proportion of the myocardial mass. Coronary artery bypass grafting (CABG) has traditionally been considered the gold standard treatment. However, advancements in drug-eluting stents (DES), intracoronary imaging, and procedural techniques have expanded the role of percutaneous coronary intervention (PCI) for LMCA disease.

Objective

To evaluate procedural success, clinical outcomes, and predictors of adverse events following LMCA stenting in contemporary interventional cardiology practice.

Methods

A prospective observational study was conducted involving 250 patients undergoing LMCA stenting between January 2020 and December 2024. Clinical, angiographic, procedural, and follow-up data were analyzed. Primary endpoints included major adverse cardiovascular events (MACE), mortality, myocardial infarction, target lesion revascularization, and stent thrombosis.

Results

Procedural success was achieved in 97.2% of cases. At 12-month follow-up, MACE occurred in 10.8% of patients. Cardiac mortality was 3.2%, myocardial infarction occurred in 2.8%, target lesion revascularization in 4.0%, and definite stent thrombosis in 0.8%. Intravascular ultrasound-guided PCI demonstrated significantly lower MACE rates compared to angiography-guided procedures (7.5% vs. 15.4%, p=0.021).

Conclusion

LMCA stenting provides excellent procedural success and favorable medium-term clinical outcomes when performed using contemporary techniques and imaging guidance. Intracoronary imaging significantly improves outcomes and should be considered standard practice.