ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Outcome of Contemporary Unprotected Left Main Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction
Provisionally accepted
Hong Nyun Kim1,2
Jang Hoon Lee1,2*
Bo Eun Park1,2
Yoon Jung Park1,2Jong Sung Park1,2Nam Kyun Kim1,2Youngjun Wi1Dong Heon Yang1,2
Hun Sik Park1,2
Yongkeun Cho1,2Myung Ho Jeong3Jong-Seon Park4- 1Kyungpook National University Hospital, Daegu, Republic of Korea
- 2Kyungpook National University, Daegu, Republic of Korea
- 3Chonnam National University Hospital, Dong-gu, Republic of Korea
- 4Yeungnam University College of Medicine, Daegu, Republic of Korea
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Background Limited data are available on clinical characteristics and outcomes in patients with culprit or non-culprit left main coronary artery (LMCA) stenosis between ST-segment elevation myocardial infarction (STEMI) and non-STEMI. Methods This study aimed to compare treatment pattern and outcome between STEMI and non-STEMI according to culprit and non-culprit LMCA stenosis. We examined 572 patients with LMCA stenosis from the Korean Acute Myocardial Infarction Registry–National Institute of Health database. Major adverse cardiac and cerebrovascular events (MACCE) were defined as all-cause death, nonfatal myocardial infarction (MI), repeat revascularization, cerebrovascular accident, rehospitalizations, and stent thrombosis. Results In patients with culprit LMCA stenosis, cardiogenic shock (50.5% vs. 12.1%; P < 0.001) and use of mechanical hemodynamic support (48.5% vs. 11.0%; P < 0.001) were significantly greater in STEMI than in non-STEMI. In-hospital mortality (32.3% vs. 8.1%, P < 0.001) and 3-year MACCE (56.6% vs. 42.2%; log-rank P = 0.003) were significantly higher in STEMI. Intravascular ultrasound improved outcomes of culprit LMCA stenosis (23.1% vs. 68.1%, log-rank P = 0.001). Acute kidney injury, multiple organ failure, and cardiopulmonary resuscitation were independently associated with MACCE 2 in STEMI. In patients with non-culprit LMCA stenosis, there were no significant differences in MACCE between STEMI and non-STEMI (31.3% vs. 34.8%, log-rank P = 0.530). Concurrent percutaneous coronary intervention (PCI) for non-culprit LMCA stenosis during PCI for other culprit vessel segments did not improve MACCE in STEMI (29.5% vs. 32.9%; log-rank P = 0.660). Conclusions PCI for culprit LMCA stenosis is challenging in both STEMI and non-STEMI despite appropriate mechanical hemodynamic support. Concurrent PCI for non-culprit LMCA stenosis in STEMI does not improve MACCE.
Keywords: acute myocardial infarction, KAMIR-NIH Registry, Left Main Percutaneous Coronary Intervention, prognosis, Unprotected left main coronary artery
Received: 09 Aug 2025; Accepted: 30 Nov 2025.
Copyright: © 2025 Kim, Lee, Park, Park, Park, Kim, Wi, Yang, Park, Cho, Jeong and Park. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jang Hoon Lee
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