Impact of right coronary artery disease on mortality in patients undergoing percutaneous coronary intervention of unprotected left main coronary artery disease

Abstract

Many operators are discouraged from attempting percutaneous coronary intervention (PCI) of the left main coronary artery in the presence of a right coronary artery (RCA) stenosis, due to the perceived increased risk of periprocedural complications and poor clinical outcome at follow-up. The aim of this study was to asses if the impact of PCI on the clinical outcome of left main patients differed significantly relative to the presence of RCA disease. A total of 255 consecutive patients undergoing PCI of the left main coronary artery were analysed. Patients were subdivided into "RCA disease" (n=113) and "no RCA disease" (n=142) groups. In the RCA disease group, 33 (29.2%) patients had a chronic total occlusion (CTO). The primary endpoint was the incidence of cardiac death at 3-year follow-up. Patients with RCA disease showed a higher rate of cardiac death (17.7%) compared with those without (6.7%, p=0.056). Patients with a CTO in the RCA had a significantly higher cardiac mortality (30.0%) compared with patients without RCA disease (6.7%, p=0.015) and patients without RCA disease or a >50-99% RCA stenosis combined (8.8%, p=0.021). The presence of residual RCA disease significantly predicted the occurrence of cardiac death (HR 4.41, 95% CI 1.55-12.51, p=0.005). Patients with unprotected left main disease treated with PCI have worse outcome in terms of cardiac mortality when the RCA is diseased, especially when a CTO is present.