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 afterleft 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 arterydisease, the involvement of stemming arteries and their mismatch. For these reasons, research is seekingto identify new specific predictors that are relevant to this patient population. Simple variables, includingstenting strategy, SYNTAX (SYNergy between percutaneous coronary interventions with TAXus and cardiacsurgery) score, angles and plaque distribution carry a prognostic value and may be useful to drive decisionsin distal left main disease. We reviewed the evidences to date that specifically address the treatment of leftmain bifurcations, with emphasis on emerging prognostic determinants in this challenging scenario.