Technological Advances Are Associated With Better Clinical Outcomes of Percutaneous Coronary Intervention in Patients With Unprotected Left Main Disease

Abstract

Background Few large‐scale studies have evaluated the effectiveness of percutaneous coronary intervention (PCI) technological advances in the treatment of patients with unprotected left main coronary artery disease (LM‐CAD). We aim to identify independent factors that affect the prognosis of PCI in patients with unprotected LM‐CAD and to assess the impact of PCI technological advances on long‐term clinical outcomes. Methods and Results A total of 4512 consecutive patients who underwent unprotected LM‐CAD PCI at Fuwai Hospital from 2004 to 2016 were enrolled. Multivariable Cox proportional hazards model was used to identify which techniques can independently affect the incidence of major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, or target vessel revascularization). The incidence of 3‐year MACEs was 9.0% (406/4512). Four new PCI techniques were identified as the independent protective factors of MACEs, including second‐generation drug‐eluting stents (hazard ratio [HR], 0.61 [95% CI, 0.37–0.99]), postdilatation (HR, 0.75 [95% CI, 0.59–0.94]), final kissing balloon inflation (HR, 0.78 [95% CI, 0.62–0.99]), and using intravascular ultrasound (HR, 0.78 [95% CI, 0.63–0.97]). The relative hazard of 3‐year MACEs was reduced by ≈50% with use of all 4 techniques compared with no technique use (HR, 0.53 [95% CI, 0.32–0.87]). Conclusions PCI technological advances including postdilatation, second‐generation drug‐eluting stent, final kissing balloon inflation, and intravascular ultrasound guidance were associated with improved clinical outcomes in patients who underwent unprotected LM‐CAD PCI.