Single stent versus two stent strategy in primary PCI for unprotected LM occlusion

Abstract

Abstract Background Acute MI due to left main coronary artery (LMCA) occlusion carry the highest anatomical risk for morbidity and mortality during primary PCI. Although several clinical trials compared different PCI techniques and strategies for LMCA, still special populations and different clinical scenarios have lack of evidence about ideal approaches. Purpose We aim to compare provisional stenting versus two stent upfront technique in acute MI due to LMCA occlusion regarding short term clinical outcomes. Methods This was a prospective observational study from three large centers within the period from February 2019 to Feb 2023. Patients with acute STEMI due to LMCA occlusion who are candidates for primary PCI were included and was assigned to two groups according to operator discretion. Group I (provisional stenting) versus group II (upfront two stent strategy). Our primary outcome was MACE within 30 days and secondary Outcomes were angiographic outcomes after intervention including TIMI flow, CTFC and myocardial blush. Results A total of 62 patients met our inclusion criteria, mean age (62.64±8.61), 24.6% women. Thirty-eight patients in group I undergone provisional stenting and twenty-four patients in group II undergone two stent strategy. MACE was significantly higher in the two-stent strategy group (61.62% vs 40.34%, P<0.001] compared with provisional stenting group. the IV epinephrine group. Angiographic outcomes were significantly better in provisional stenting group by the end of the procedure. There was marked increase in patients who achieved postprocedural TIMI III and TMPG III in group I by 22% and 18% respectively in comparison with two stent strategy group. Conclusion Our observational study concluded that provisional stenting carries better short-term outcomes in acute MI intervention due to unprotected LMCA occlusion. Clinical studies are needy in this specific population.Study flow chartFigure I