A focused update on emerging prognostic determinants in distal left main percutaneous coronary intervention

A distal location of the atherosclerotic plaque is one of the most powerful predictors of adverse events after left main angioplasty. However, bifurcations are not alike and may differ with regards to a number of variables, including the angle of the bifurcation, the presence of a ramus, the burden of downstream coronary artery disease, the involvement of stemming arteries and their mismatch. For these reasons, research is seeking to identify new specific predictors that are relevant to this patient population. Simple variables, including stenting strategy, SYNTAX (SYNergy between percutaneous coronary interventions with TAXus and cardiac surgery) score, angles and plaque distribution carry a prognostic value and may be useful to drive decisions in distal left main disease. We reviewed the evidences to date that specifically address the treatment of left main bifurcations, with emphasis on emerging prognostic determinants in this challenging scenario.