# Percutaneous Coronary Intervention for Left Main Disease in High Bleeding Risk: Outcomes from a Subanalysis of the Delta 2 Registry

## TL;DR

This study examines outcomes of high bleeding risk patients undergoing left main coronary artery stenting, finding higher mortality and heart attack rates compared to lower risk patients.

## Contribution

The study provides new insights into the risks and outcomes of high bleeding risk patients undergoing left main PCI using a large international registry.

## Key findings

- HBR patients had higher in-hospital mortality (1.8% vs. 0.2%) and myocardial infarction rates (5.0% vs. 2.1%).
- At follow-up, HBR patients had over three times higher primary endpoint rate (20.8% vs. 6.1%) driven by all-cause death.
- No significant difference in stent thrombosis or target lesion revascularization was observed between HBR and non-HBR patients.

## Abstract

High bleeding risk (HBR) is a challenge in patients with complex coronary lesions undergoing percutaneous coronary intervention (PCI). This study investigates HBR in a wide and comprehensive cohort of patients undergoing left main (LM) PCI and reports in-hospital and follow-up outcomes. The analysis was performed on data from the DELTA (Drug Eluting Stent for Left Main Coronary Artery) 2 Registry, which included patients who underwent LM PCI at 19 centres worldwide. The patients were defined to be at HBR if ≥1 major criterion or ≥2 minor criteria from the Academic Research Consortium (ARC) were met. The primary endpoint was a composite of all-cause death, myocardial infarction (MI) or cerebrovascular accident (CVA) at median follow-up. A total of 1531 patients were included, and the rate of HBR was 65.8%. Besides the different clinical characteristics embedded in the ARC definition, HBR patients had higher prevalence of acute coronary syndrome (ACS) at presentation (49.2% vs. 26.8%, p < 0.001) and experienced higher in-hospital mortality (1.8% vs. 0.2%; p = 0.029) and MI (5.0% vs. 2.1%, p = 0.009). The median follow-up was 473 days. The rate of the primary endpoint was more than three times higher in HBR patients (20.8% vs. 6.1%; HR 3.3; 95%CI: 2.2–4.8) and driven by all-cause death at multivariate regression analysis. Conversely, no significant difference in target lesion revascularization and probable or defined stent thrombosis was reported. HBR patients undergoing LM PCI experienced higher rates of all-cause death at follow-up; similar outcomes were also reported in-hospital.