Unprotected left main (ULM) percutaneous coronary intervention (PCI) procedures represented less than 1 percent of all PCIs in clinical practice in the United States from 2009 through 2016, according to a study published online Jan. 2 in JAMA Cardiology.

Javier A. Valle, M.D., from the Rocky Mountain Veterans Affairs Medical Center in Aurora, Colorado, and colleagues analyzed data from the National Cardiovascular Data Registry CathPCI Registry (1,662 institutions; 33,128 patients undergoing ULM PCI and 3,309,034 patients undergoing all other PCIs between April 2009 and July 2016). The authors sought to assess current practice of ULM PCI and its outcomes. These results were compared to findings reported in clinical trials.

The researchers found that ULM PCI represented 1.0 percent of all procedures during the study period, with a modest increase from 0.7 to 1.3 percent over time. Only 1,808 of 10,971 operators (16.5 percent) and 892 of 1,662 facilities (53.7 percent) performed an average of at least one ULM PCI annually, with a mean annualized ULM PCI volume of 0.5 procedures for operators and 3.2 procedures for facilities. Major adverse clinical events occurred more frequently with ULM PCI versus all other PCIs (odds ratio, 1.46) after adjustment for other factors. Compared with clinical trial populations, real-world patients in the CathPCI Registry were older with more comorbid conditions and adverse events were more frequent.

"Trials of unprotected left main PCI do not reflect contemporary practice, although it is possible that case selection and procedural inexperience influence the observed discrepancies," the authors write.

Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.

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