Influence of left main-left circumflex artery angle on long-term outcomes in crossover stenting for ostial left circumflex artery lesions: insights from the Multicenter CROSS-LCX Registry.

BACKGROUND

The influence of left main bifurcation angles on cardiovascular outcomes following crossover stent implantation (CSI) in patients with ostial left circumflex artery (LCX) lesions has not been well established. This investigation sought to determine the relationship between left main bifurcation angles and poor cardiovascular outcomes in patients who underwent CSI of ostial LCX lesions.

METHODS

This large-scale, multicenter ( n  = 14) observational, retrospective study included 267 patients [men: 192 (71.9%), mean age: 66.30 ± 10.93 years] who underwent percutaneous coronary intervention with CSI for ostial LCX lesions. The primary outcome was major adverse cardiac events (MACE), including cardiac death, target vessel revascularization, and target vessel myocardial infarction. Patients were categorized into two groups as MACE (+) and MACE (-).

RESULTS

At least one MACE occurred in 49 patients (18.3%) in the study cohort. The left main-LCX angle (108.44 ± 17.93° vs. 115.89 ± 14.760°, P  = 0.041) was significantly lower in the MACE (+) group compared to the MACE (-) group. In multivariate Cox regression analysis, increased left main-LCX angle was identified as one of the independent predictors of MACE (hazard ratios: 0.968, P  = 0.005). In the receiver operating characteristic curve analysis, a left main-LCX angle lower than 99° predicted the presence of MACE with a sensitivity of 64% and a specificity of 75% (area under the curve: 0.721, 95% confidence interval: 0.663-0.774, P  < 0.001). The prevalence of MACE was notably higher in patients with left main-LCX angle <99° as compared to others (53.3 vs. 11.3%, P  < 0.001).

CONCLUSIONS

This multicenter study shows that a narrow left main-LCX angle (99°) value may be associated with poor cardiovascular events in patients who underwent CSI for ostial LCX disease.