Background: Optimal stenting for distal unprotected left main coronary artery (LMCA) bifurcation disease remains uncertain. We evaluated long-term outcomes by initially intended strategy. Methods: This retrospective, single-centre cohort included 234 consecutive patients undergoing percutaneous coronary intervention (PCI) without acute coronary syndrome, classified by intended strategy irrespective of crossover. Cox models for all-cause mortality were adjusted for strategy, age, left ventricular ejection fraction, SYNTAX score, and diabetes, with anatomical and propensity-score sensitivity analyses. Secondary and subgroup analyses were exploratory. Results: Provisional and upfront two-stent strategies were intended in 145 and 89 patients. Two-stent patients had greater anatomical complexity. During median 49-month follow-up, mortality did not differ significantly (two-stent versus provisional: 16.9% versus 21.4%; p = 0.499; adjusted hazard ratio, 0.83; 95% confidence interval, 0.43–1.60; p = 0.579), with consistent sensitivity analyses. Older age, lower ejection fraction, and higher SYNTAX score were associated with mortality. Target-lesion revascularisation (7.8% versus 2.1%; p = 0.033) and in-hospital stroke (5.6% versus 0.7%; p = 0.031) were more frequent with intended two-stent PCI; other secondary outcomes did not differ significantly. Exploratory unadjusted comparisons showed lower target-lesion and target-vessel revascularisation with double-kissing crush (n = 74) versus conventional culotte (n = 15), limited by small samples and selection bias. Intravascular ultrasound was associated with lower mortality in exploratory adjusted analyses. Mortality was numerically lower with elective intra-aortic balloon pump support at ejection fraction ≤40%, without statistical significance. Conclusions: No, statistically significant association between initially intended bifurcation strategy and long-term all-cause mortality was observed. Limited precision precludes an inference of equivalence, and exploratory differences in target-lesion revascularisation and in-hospital stroke warrant caution. These findings provide a long-term real-world perspective on individualised distal LMCA PCI, integrating lesion complexity, ventricular reserve, procedural technique, and intravascular imaging.

Acute coronary syndrome (ACS) encompasses a spectrum of conditions caused by the sudden, reduced blood flow to the myocardium, leading to myocardial ischemia and, in severe cases, infarction. The primary pathophysiological mechanism involves the rupture of an atherosclerotic plaque within a coronary artery, resulting in thrombus formation. Plaque rupture exposes subendothelial elements, activating platelets and initiating a coagulation cascade that leads to clot development. The extent and stability of the thrombus determine the severity of coronary obstruction, with partial blockage causing unstable angina and complete occlusion leading to myocardial infarction. Other contributory factors include coronary vasospasm, endothelial dysfunction, and inflammation. The ischemic damage caused by ACS disrupts myocardial cell membranes, releasing cardiac biomarkers such as troponin into the bloodstream. Early recognition and intervention are critical in ACS management to restore perfusion and minimize myocardial injury.

Introduction/Purpose: In patients with paroxysmal atrial fibrillation (PAF), functional changes are observed in the left atrium (LA) after the pulmonary vein isolation (PVI) procedure. Although previous studies have investigated the altered mechanical functions of the LA with radiofrequency (RF) ablation, changes in the LA functions in the early period after cryoablation (CB-2) and the relationship between early period serial echocardiographic follow-ups after cryoablation and recurrence of atrial fibrillation/atrial tachycardia (AF/AT) have not been clearly demonstrated. This study aims to determine changes in the mechanical functions of LA in patients with PAF during the early period after cryoablation and whether these changes are effective in predicting the risk of recurrence by using echocardiographic parameters including Doppler and strain parameters. Methods: Consecutive seventy-seven patients (mean age: 57.5±11.2 years; 57% men) with PAF underwent CB-2 and were prospectively analyzed. All patients were in sinus rhythm before and after the procedure. The LA dimensions, the LA reservoir strain (LASr), the LA atrial contractile strain (LASct), the LA conduit strain (LAScd) and left ventricular diastolic function parameters were evaluated by Doppler echocardiography before and 3 months after the procedure. Patients were monitored with 48-hour Holter at 1-3-6-12th months after the procedure to evaluate for recurrence. Results: Acute procedural success was achieved in all cases. No major complications were observed. LASr and LASct showed significant recovery after the procedure (28.3±12.8% vs 34.6±13.8%, p3 months) of AF/AT was observed in 9 (11.7%) patients. Although the power of echocardiographic parameters in predicting recurrence was found to be not statistically significant, a downward trend especially in the values of LASr (p=0.068) and LASct (p=0.058) was observed at the 3rd month control echocardiographic results in patients with recurrence. Conclusion: Significant improvement in mechanical functions may occur even in the early period after cryoballoon ablation in patients with PAF. In addition, as our study points out strain parameters, indicators of mechanical function tend to decline in patients with late term recurrence.