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

Abstract

Background: The management of unprotected left main coronary artery disease (LM CAD) poses a significant clinical challenge. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) have been extensively compared, with PCI emerging as a viable option for specific patient subsets. Advancements in interventional cardiology, including drug-eluting stents and intravascular ultrasound, have improved PCI outcomes, yet long-term efficacy remains a subject of investigation. Objective: This study aims to evaluate the long-term outcomes of PCI in patients with unprotected LM CAD, focusing on all-cause mortality, cardiac deaths, myocardial infarction, revascularization, and stroke. Methods: A descriptive cross-sectional study was conducted at the Peshawar Institute of Cardiology, KPK, from November 2022 to October 2023. A total of 120 patients aged 55-70 years with LM disease undergoing PCI were included. Long-term outcomes were assessed after five years. Data analysis was performed using SPSS version 23, focusing on frequency and association of outcomes with gender. Results: The study observed all-cause mortality in 15.0% (n=18) of the patients, cardiovascular mortality in 6.7% (n=8), myocardial infarction in 7.5% (n=9), revascularization in 14.2% (n=17), and stroke in 4.2% (n=5). Gender analysis revealed no significant difference in all-cause mortality (P=0.73), with a notable gender disparity in cardiovascular mortality favoring females (P=0.04). Revascularization and stroke rates did not significantly differ by gender. Conclusion: PCI presents a favorable and safe long-term treatment option for patients with unprotected LM CAD, with significant outcomes in terms of mortality, myocardial infarction, revascularization, and stroke. The study supports the continued use of PCI in clinical practice, highlighting the necessity for further comparative research with CABG to optimize patient outcomes.