Impact of Calcification Location in the Left Main Coronary Artery Bifurcation on Short-Term Prognosis After Left Main Stenting.

BACKGROUND

The effect of the location of calcification in the left main coronary artery (LMCA) bifurcation on cardiovascular events remains unclear.

METHODS AND

RESULTS

This retrospective study included 498 patients who underwent LMCA stenting at a single center between 2014 and 2018. Moderate or severe calcification was visually assessed by coronary angiography. The primary endpoint was 3-year target lesion failure (TLF), defined as cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Most patients (n=314; 63.1%) had no calcification in the LMCA bifurcation. One-segment calcification was observed in 45 (9.0%) patients, primarily in the left anterior descending artery (LAD; n=43 [8.6%]). Two-segment calcification was observed in 81 (16.3%) patients, most commonly involving the LMCA and LAD (n=70; 14.1%). Three-segment calcification was observed in 58 (11.6%) patients. Overall, 58 (11.6%) patients developed TLF within 3 years. Multivariable Cox regression analysis revealed a significant association between calcification in the left circumflex artery (LCX) and 3-year TLF (adjusted hazard ratio [aHR] 4.46; 95% confidence interval [CI] 1.81-10.99; P=0.001). In contrast, there was no significant association between calcification at the LMCA (aHR 1.29; 95% CI 0.47-3.55; P=0.623) or LAD (aHR 0.49; 95% CI 0.17-1.45; P=0.199) and the primary endpoint.

CONCLUSIONS

Moderate or severe calcification in the LCX is significantly associated with 3-year TLF in patients who have undergone LMCA stenting.