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Target Lesion Revascularization Not Linked to Increased Mortality After PCI with DES for Left Main Coronary Artery Disease

20 Mar 2024

Despite target lesion revascularization (TLR) being a known occurrence after percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease, uncertainties persist regarding its timing and impact on long-term mortality. In a recent study published in JACC Interventions, investigators explored the incidence of TLR over time and its influence on mortality following PCI with drug-eluting stents (DES) for LMCA disease.

Utilizing data pooled from four multicenter observational registries (IRIS-DES, IRIS-MAIN, MAIN-COMPARE, and PRECOMBAT), researchers assessed 1,397 patients with LMCA disease treated with DES, all with available long-term mortality data. Investigators employed multivariable Cox proportional hazards regression to examine the association between TLR and the 10-year risk of mortality, treating TLR as a time-varying covariate.

Over a maximum follow-up of 10 years (median 6.8 years), TLR occurred in 118 patients, with a 10-year cumulative incidence of 10.8%. The majority of TLR cases happened within 2 years post-initial PCI and declined thereafter: early-stage TLR (within 2 years) in 73 (61.9%) patients and late-stage TLR (beyond 2 years) in 45 (38.1%) patients. Among TLR patients, 23 underwent coronary artery bypass grafting while 95 had repeat PCI. In the time-varying multivariable Cox model, the presence of TLR did not show a significant association with an increased risk of mortality (adjusted HR: 0.90; 95% CI: 0.50-1.63; P = 0.73).

The authors summarized the key findings to include: 1) TLR related to LMCA occurred steadily over the 10-year follow-up, with a cumulative incidence of 10.8%; most TLR events happened within the first 2 years after PCI, followed by a lower rate in the subsequent years; 2) The occurrence of TLR did not significantly increase the risk of long-term all-cause or cardiac mortality, suggesting optimal revascularization in these patients; and 3) The prognostic impact of TLR on mortality remained consistent regardless of its timing, mechanisms, or locations involved.

The authors recommended that more extensive research on a larger scale, encompassing supplementary variables affecting mortality following TLR, is necessary to thoroughly investigate the prognostic significance of TLR subsequent to PCI with DES for LMCA disease.

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Original article: Kim et al. J Am Coll Cardiol Intv 2024;17:32–42.

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