Clinical and Procedural Outcomes of Left Main PCI in Indian Population: A Single-center Observational Study

Abstract

Introduction: Randomized trials and longer follow-up studies have demonstrated comparable outcomes between PCI and CABG in appropriately selected left main disease, particularly when contemporary techniques and stent platforms are used. The outcomes in this real-world cohort are broadly consistent with contemporary published evidence supporting unprotected left main PCI in appropriately selected patients. Aim: The present study evaluates the clinical, angiographic, and procedural characteristics and outcomes of left main (LM) percutaneous coronary intervention (PCI) in Indian population. Study Design: Retrospective observational study. Place and Duration of Study: Department of Cardiology, Apollo Speciality Hospitals, Vanagaram, Chennai, India; January 2025 to December 2025. Methodology: A total of 100 consecutive patients undergoing unprotected LM PCI were included. baseline clinical data, angiographic characteristics, procedural strategies, and in-hospital as well as follow-up outcomes were collected. The primary endpoint was procedural success. Secondary endpoints included in-hospital, 30-day, and 1-year major adverse cardiovascular events (MACE), acute kidney injury (AKI), stent thrombosis, and restenosis. Results: The mean age was 65.7 ± 12.4 years, and 50% of patients were female. Diabetes mellitus was present in 64%, and mean BMI was 28.4 ± 3.3 kg/m². Distal LM bifurcation disease was the predominant anatomical pattern (64%), with a mean SYNTAX score of 30.6 ± 7.5. Femoral access was used in 86% of procedures. Intravascular imaging was utilized in 40% (OCT 30%, IVUS 10%). A two-stent strategy was employed in 47% of cases, with proximal optimization technique performed in 78%. Procedural success was achieved in 88%. In-hospital MACE occurred in 5%, while 30-day and 1-year MACE rates were 11% and 16%, respectively. AKI was observed in 10%, stent thrombosis in 1%, and restenosis in 11%. Conclusion: In this real-world Indian cohort with high clinical and anatomical complexity, unprotected LM PCI achieved high procedural success with acceptable short- and mid-term outcomes. Contemporary drug-eluting stents, selective intravascular imaging, and consistent stent optimization strategies supported favourable results in routine clinical practice.