Temporal Evolution of Left Main Coronary Artery Stenosis <i>De Novo</i> Presentation: Trends in Coronary Angiography and Clinical Characteristics (LM‐EVOLUTION Study)

Background: Cardiovascular diseases evolve over time; this may affect treatment. We investigated angiographic trends in patients presenting with de novo left main coronary artery (LM) stenosis over a decade. Methods: Clinical records and all consecutive coronary angiograms performed in our Institution between 2011 and 2020 were reviewed to identify subjects with newly diagnosed significant (≥ 50% lumen diameter reduction by quantitative angiography) LM stenosis. Values of the overall SYNTAX score (SS), LM lesion SS (LM‐SS) and SS for lesion(s) beyond LM (non‐LM‐SS) were assessed as per angiographic core labolatory protocol. Results: Out of 12,524 coronary angiograms in de novo referrals, 372 (2.97%) showed significant LM stenosis; the proportion varied from 2.30% to 3.48% annually. LM patients’ mean age was 69.12 ± 9.75 years (22.95% women). No temporal age/gender trends could be identified. Overall, SS decreased from a mean value of 35 to 27 (Spearman correlation coefficient, SC = −0.17, p = 0.001). This was driven by reduction in non‐LM‐SS (SC = −0.18, p &lt; 0.001) while LM‐SS was not changing in time (SC = 0.04, p = 0.40). No temporal trends were present in LM stenosis segmental location (ostial/mid/bifurcation, p &gt; 0.05 for all), its angiographic severity (&lt; 70% vs. ≥ 70%; p = 0.35) or in the number of LM segments affected ( p = 0.19). Isolated LM stenosis presentations increased over time ( Z = 2.07, p = 0.039). The reduction in non‐LM‐SS was associated primarily with a trend towards reduction in number of coexisting non‐LM lesions requiring revascularization (SC = −0.09, p = 0.07). Conclusions: In consecutive patients presenting with de novo LM stenosis, angiographic SS showed a statistically significant negative trend over a decade, driven primarily by a reduction in non‐LM‐SS. Our findings are consistent with an increase in the proportion of patients presenting with LM stenosis amenable to first‐line percutaneous (rather than surgical) management (LM‐EVOLUTION study).