Impact of Routine CCTA After Left-Main PCI | JACC | ESC 2025

In this JACC interview, JACC Executive Associate Editor Karthik Murugiah, MD, FACC, speaks with lead author Fabrizio D'Ascenzo, MD, PhD, as they review the randomized, multicenter PULSE trial. In the study (606 patients with unprotected left main PCI), routine 6-month CCTA surveillance did not lower the 18-month composite of death, myocardial infarction, unstable angina, or stent thrombosis compared with symptom-based follow-up. CCTA was associated with a lower rate of spontaneous MI (0.9 % vs 4.9 %) and more imaging-guided revascularizations (4.9 % vs 0.3 %). These findings suggest routine CCTA may not be necessary for all patients, but targeted use could inform earlier intervention. Additionally, the trial was powered for large risk reduction; thus, smaller but clinically meaningful benefits could still exist but remain undetected. This study is presented at ESC as a late-breaking clinical trial and simultaneously published in JACC.