Unprotected Left Main Percutaneous Coronary Intervention in Patients With Moderate-to-Severe Left Ventricular Dysfunction: 15-Year Single-Centre Experience Without Routine Mechanical Support

Abstract

Background

Left main coronary artery disease in patients with significant left ventricular (LV) dysfunction is associated with elevated procedural risk for both surgical and percutaneous interventions. Mechanical circulatory support is increasingly used empirically for high-risk percutaneous coronary interventions (PCI), but availability remains limited in many catheterisation laboratories. We report outcomes of unprotected left main PCI (LM-PCI) in patients with moderate-to-severe LV dysfunction (LVEF ≤ 35%) performed without routine periprocedural mechanical support over 15 years at a tertiary New Zealand centre.

Methods

Patients undergoing unprotected LM-PCI at North Shore Hospital between December 2007 and September 2023 were retrospectively identified. Baseline demographics, procedural characteristics, and outcomes were collected. Primary outcomes included in-hospital mortality, 30-days mortality, and 1-year all-cause mortality. Secondary outcomes were major adverse cardiovascular events (MACE) within 1 year, including cardiogenic shock, myocardial infarction, stroke, target vessel revascularisation, and procedural complications.

Results

Seventy-four eligible cases were analysed for this study. Median age was 72 years. 74.3% had severely impaired LVEF of 30% or less. Indications for coronary intervention included NSTEMI (41.9%), cardiomyopathy (28.4%), STEMI (8.1%), and cardiac arrest (9.5%). In-hospital mortality was seen in 1 patient (1.4%), with no death at 30 days. One-year mortality was 8.1%. Total MACE outcomes at 1-year occurred in 3 patients (4.4%); all myocardial infarction, and 1 of these patients (1.5%), had target vessel revascularisation.

Conclusion

In our retrospective single-centre analysis, we found low rates of mortality and MACE, in unprotected LM-PCI cases without periprocedural mechanical haemodynamic support, in patients with moderate to severely impaired LVEF. These data suggest that careful patient selection and procedural planning may allow safe LM-PCI in high-risk patients even when mechanical circulatory support is not available.