Aortic Valve (TAVR/TAVI)Monday, October 19, 2026

Intravascular imaging improves outcomes in left main PCI: insights from acute and chronic presentations.

1 min read·By E. Nolan Beckett, MD·Source: Acta cardiologica

Key Numbers

80.4% male

40.9% vs

15.8%

29.5% vs

From The Valve Wire

A retrospective single-center series of 107 left main PCI patients (19 chronic coronary syndrome, 88 ACS) found higher MACCE (40.9% vs 15.8%) and mortality (29.5% vs 5.3%) in ACS presentations over roughly 3 years.

Intravascular imaging guidance was associated with lower MACCE in multivariable Cox analysis (HR 0.32, 95% CI 0.14-0.75), but after stabilized inverse probability weighting the effect attenuated to HR 0.57 with a confidence interval crossing one (p=0.178).

The authors deserve credit for reporting the weighted analysis rather than leading with the unadjusted hazard ratio.

The honest read is that 107 patients cannot settle this, and the imaging effect here is directionally consistent with the larger randomized data (ILUMIEN IV, OCTOBER, RENOVATE-COMPLEX-PCI) rather than independent confirmation of it.

Source Abstract

BACKGROUND: Percutaneous coronary intervention (PCI) has emerged as an established revascularization strategy for selected patients with left main coronary artery (LMCA) disease. However, data regarding outcomes in unselected real-world populations and the impact of intravascular imaging remain limited. We aimed to evaluate clinical outcomes following LMCA PCI according to clinical presentation and to assess the prognostic impact of intravascular imaging guidance. METHODS: We conducted a retrospective single-centre study including consecutive patients undergoing LMCA PCI between 2019 and 2022. Patients were classified as having chronic (CCS) or acute coronary syndrome (ACS). Major adverse cardiac and cerebrovascular events (MACCE) were assessed during follow-up. Kaplan-Meier and Cox regression and stabilised inverse probability of treatment weighting (SIPTW) analyses were performed. RESULTS: A total of 107 patients were included (19 CCS and 88 ACS; mean age 68.6 ± 11.3 years; 80.4% male). During a mean follow-up of 1121 ± 574 days, ACS patients experienced higher rates of MACCE (40.9% vs. 15.8%; p = 0.039) and all-cause mortality (29.5% vs. 5.3%; p = 0.027) compared with CCS patients. Intravascular imaging-guided PCI was associated with a significantly lower risk of MACCE in multivariable analysis (HR 0.32, 95% CI 0.14-0.75; p = 0.009). In a SIPTW-adjusted analysis, the association remained directionally favourable, although statistical significance was not maintained (HR 0.57, 95% CI 0.26-1.29; p = 0.178). CONCLUSIONS: Clinical presentation significantly influences outcomes after LMCA PCI, with worse long-term prognosis among ACS patients. Intravascular imaging-guided PCI was associated with lower rates of MACCE and remained directionally favourable after weighting analyses, supporting its role in optimising LMCA interventions.

Authors: Fernandes ASN, Dias MPS, Ferreira CRO, Vilela FXS, Rodrigues CQ et al.

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Full article at Acta cardiologica

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