Right coronary artery patency as a modulator for unprotected left main PCI risk: myth or reality?

Abstract

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Impact of chronic total occlusion on prognosis in cardiogenic shock due to unprotected left main coronary artery culprit lesion. Insights from the Polish Registry of Acute Coronary Syndromes

“…Finally, some studies showed that in stable patients undergoing unprotected left main PCI, CTO of the right coronary artery (RCA) may be associated with increased risk of periprocedural complications and mortality [27,28]. This may be because during unprotected left main PCI, a large region of myocardium is jeopardized, and in the absence of a patent RCA, hemodynamic deterioration is more likely [28].…”

“…Finally, some studies showed that in stable patients undergoing unprotected left main PCI, CTO of the right coronary artery (RCA) may be associated with increased risk of periprocedural complications and mortality [27,28]. This may be because during unprotected left main PCI, a large region of myocardium is jeopardized, and in the absence of a patent RCA, hemodynamic deterioration is more likely [28]. However, not all studies found a negative effect of the lack of RCA flow on outcomes, which may be partially explained by differences between studies in left main PCI complexity, clinical characteristics of included patients, or clinical context [28,29].…”

“…This may be because during unprotected left main PCI, a large region of myocardium is jeopardized, and in the absence of a patent RCA, hemodynamic deterioration is more likely [28]. However, not all studies found a negative effect of the lack of RCA flow on outcomes, which may be partially explained by differences between studies in left main PCI complexity, clinical characteristics of included patients, or clinical context [28,29]. Indeed, our study showed that in the setting of CS, the prognosis of patients with ULMCL and any CTO is poor, irrespective of CTO location.…”