Acute percutaneous coronary intervention (PCI) of the left main coronary artery was associated with higher complication rates than subacute or elective procedures. Results were presented at the European Society of Cardiology (ESC) Congress 2025.

This single-center, retrospective analysis included 824 patients undergoing left main PCI. The cohort was divided by urgency: acute (20%), subacute (36%), and elective (44%). The median age was 76 years. Cardiovascular risk factors were common, including dyslipidemia (81%), hypertension (85%), and diabetes (27%).

Patients undergoing acute PCI were more often anemic (60%), had acute kidney injury (52%), and severely reduced left ventricular ejection fraction (<30%, 57%). Procedure times and contrast volume were higher in acute cases. Mechanical circulatory support with ECMO was used more frequently (25%), and intraprocedural arrhythmias occurred in 18%.

Major adverse cardiac events occurred in 41.5% of acute cases, compared with 13% and 8% in subacute and elective procedures. Multivariate analysis identified age >75 years and cardiogenic shock as predictors of adverse outcomes in acute cases. Reduced left ventricular function predicted events in subacute and elective PCI. Acute left main PCI carried higher in-hospital risk, emphasizing careful patient selection and risk stratification.