At the European Society of Cardiology (ESC) Congress 2025 in Madrid, researchers from the University Heart and Vascular Centre Hamburg presented a 12-year analysis of in-hospital outcomes in patients undergoing left main percutaneous coronary intervention (LM-PCI). The study focused on how procedural urgency; acute, subacute, or elective affects complication rates and survival.

The retrospective cohort included 824 patients treated between 2012 and 2023, with a median age of 76 years and a high prevalence of cardiovascular risk factors such as hypertension (85%), dyslipidemia (81%), and diabetes (27%). Acute LM-PCI accounted for 20% of cases, subacute for 36%, and elective for 44%.

Patients undergoing acute procedures had more severe comorbidities, including higher rates of anemia, acute kidney injury, and severely impaired left ventricular function. These cases were more complex, requiring longer procedure times, greater use of contrast agents, and frequent reliance on mechanical circulatory support. Complications such as arrhythmias were also markedly higher.

The primary endpoint, which is a composite of all-cause mortality, myocardial infarction, and stroke (MACE) occurred in 41.5% of acute LM-PCI patients, compared to 13% in subacute and 8% in elective cases. Age over 75 years and cardiogenic shock emerged as independent predictors of poor outcomes in acute cases, while reduced ejection fraction predicted risk in subacute and elective groups.

The findings highlight the urgent need for improved risk stratification and earlier identification of patients at risk of left main coronary artery disease, potentially allowing more cases to be treated in elective or subacute settings rather than as emergencies. Future research may focus on refining patient selection, optimizing procedural planning, and developing strategies to mitigate risk in acute interventions, such as earlier hemodynamic support or novel stenting techniques.