Impact of Polyvascular Disease in Patients undergoing unprotected Left Main Percutaneous Coronary Intervention

Percutaneous coronary intervention (PCI) has demonstrated its safety and efficacy in treating left main coronary artery disease (LM-CAD) in select patients. Polyvascular disease (PolyVD) is associated with adverse events in all-comers with CAD. However, there is little data examining the interplay between PolyVD and LM-PCI, which we sought to investigate in a retrospective single-center study. We included patients undergoing unprotected LM-PCI at a tertiary center from 2012-2019. The patient population was stratified based on the presence or absence of PolyVD (i.e. medical history of cerebrovascular and/or peripheral artery disease in addition to LM-CAD). The primary outcome was major adverse cardiovascular events (MACE) combining all-cause mortality and spontaneous myocardial infarction within one year after index PCI. Overall, 869 patients were included, and 23.8% of the population had PolyVD. Individuals with PolyVD were older and had a greater burden of comorbidities. After 1 year follow-up individuals with PolyVD exhibited significantly higher rates of both MACE (22.8% vs. 9.4%; p<0.001) and bleeding events compared to those without PolyVD. MACE was primarily driven by an increase in all-cause mortality (18.3% vs. 7.1%; p<0.001). Results persisted after adjusting for confounders. In conclusion, among patients undergoing LM-PCI, the presence of PolyVD is linked to an increased risk of MACE and bleeding after 1 year of follow-up, which highlights the vulnerability of this patient population.