Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Nov 11;86(19):1724-1734.
doi: 10.1016/j.jacc.2025.07.060. Epub 2025 Aug 31.

Computed Tomography Angiography or Standard Care After Left Main PCI?

Fabrizio D'Ascenzo  1 , Enrico Cerrato  2 , Ovidio De Filippo  3 , Luca Gaido  4 , Alfonso Franzè  2 , Mario Iannaccone  5 , Wojciech Wańha  6 , Andrea Santarelli  7 , Vincenzo Guiducci  8 , Umberto Barbero  9 , Carlos Fernandez Pereira  10 , Marco Gatti  11 , Matteo Tebaldi  12 , Massimo Giammaria  4 , Giacomo Boccuzzi  5 , Wojciech Wojakowski  6 , Gianluca di Pietro  13 , Roberto Placido  14 , Sebastiano Gili  15 , Alessandro Depaoli  16 , Giuseppe Biondi Zoccai  17 , Francesco Tomassini  18 , Francesco Bruno  19 , Daniela Zugna  20 , Riccardo Faletti  11 , Simone Biscaglia  21 , Serena Caglioni  21 , Ferdinando Varbella  2 , Gaetano Maria de Ferrari  1 , Gianluca Campo  21
Affiliations
Randomized Controlled Trial

Computed Tomography Angiography or Standard Care After Left Main PCI?

Fabrizio D'Ascenzo et al. J Am Coll Cardiol. .

Abstract

Background: The clinical benefit of routine coronary computed tomography angiography (CCTA) after percutaneous coronary intervention (PCI) for unprotected left main (LM) disease is uncertain.

Objectives: The authors evaluated whether CCTA-guided follow-up improves clinical outcomes vs symptoms- or ischemia-driven care after LM PCI.

Methods: PULSE was a prospective, multicenter, open-label randomized trial. A total of 606 patients treated with second-generation drug-eluting stents were enrolled (October 2019 to September 2024) and randomized 1:1 to CCTA at 6 months (experimental) or standard care (control). The primary endpoint was a composite of all-cause death, spontaneous myocardial infarction (MI), unstable angina, or definite or probable stent thrombosis at 18 months. Secondary endpoints included target-lesion revascularization (TLR) and each primary endpoint component.

Results: CCTA was completed in 272/303 experimental patients (89.8%) after a median of 200 days (IQR: 181-270 days). The primary endpoint occurred in 36/303 experimental patients vs 38/303 control patients (11.9% vs 12.5%; HR: 0.97; 95% CI: 0.76-1.23; P = 0.80). Compared with the control arm, the CCTA arm showed a reduced risk of spontaneous MI (0.9% vs 4.9%; HR: 0.26; 95% CI: 0.07-0.91; P = 0.004) and an increased risk of imaging-triggered TLR (4.9% vs 0.3%; HR: 7.7; 95% CI: 1.70-33.7; P = 0.001), whereas clinically driven TLR rates were similar (5.3% vs 7.2%; HR: 0.74; 95% CI: 0.38-1.41; P = 0.32).

Conclusions: Routine CCTA after LM PCI did not reduce the composite primary endpoint, but was associated with fewer spontaneous MIs and more imaging-triggered revascularizations. Future trials to clarify its value in complex anatomic subsets appear to be warranted. (Angiographic Control vs Ischemia-Driven Management of Patients Treated With PCI on Left Main With Drug-Eluting Stents [PULSE; NCT04144881]).

Keywords: coronary computed tomography angiography; left main; percutaneous coronary intervention; randomized clinical trial.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures This study was funded by the Italian Ministry of Health, General Directorate for Health and Biomedical Research (project code: GR-2016-02362546). The funding body had no role in study design, data collection, data analysis, data interpretation, or article writing. Dr Biondi-Zoccai has consulted, lectured, or served as an advisory board member for Abiomed, Advanced Nanotherapies, Aleph, Amarin, AstraZeneca, Balmed, Cardionovum, Cepton, Crannmedical, Endocore Lab, Eukon, Guidotti, Innovheart, Meditrial, Menarini, Microport, Opsens Medical, Synthesa, Terumo, and Translumina, outside the present work. Dr de Ferrari has consulted, lectured and/or served advisory board member for Amgen, Daichii, Merck, Novartis, outside the present work. Dr Campo has received research grants from Abbott Vascular, SMT, and GADA, outside the present work. All other authors have no reported that they have no relationships relevant to the contents of this paper to disclose.

Publication types

Associated data