Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 21 3 2026 05 24 189 196 Karar Nadhm Aljabry Internal Medicine Department, Medicine College, University of Kufa, Najaf, Iraq Samir Abeid Internal Medicine Department, Medicine College, University of Kufa, Najaf, Iraq Yasseen Yasseen Internal Medicine Department, Medicine College, University of Kufa, Najaf, Iraq Firas Al-obaidi University of Basrah 2025 08 24 2026 04 19 Introduction: To identify the safety and long-term outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents for unprotected left main coronary artery disease (ULMCAD) and to compare outcomes between provisional single-stent and double-stent techniques. Methods: In this observational study, patients diagnosed with ULMCAD who underwent PCI were enrolled. Clinical data, angiographic characteristics, and outcomes at 1 and 3 years-including cardiac admission, cardiac death, target lesion revascularization (TLR), and major adverse cardiac and cerebrovascular events (MACCE)-were collected and analyzed at Al-Najaf Cardiac Center. Results: Between January 2014 and January 2017, 500 patients were included in the study. Mean (SD) age was 65 (11) years, 364 patients (72.8%) were male, and hypertension was the most common risk factor, occurring in 353 patients (70.5%). Distal left main lesions were predominant, occurring in 425 patients (84.9%), and the double-stenting technique was used in 356 cases (71.3%). Procedural success was 100%, with no in-hospital mortality or major complications. At 1-year follow-up, cardiac death was recorded in 4 patients (0.8%), TLR in 8 patients (1.6%), and MACCE in 16 patients (3.1%). At 3-year follow-up, cardiac death increased to 8 patients (1.6%), TLR to 20 patients (4.4%), and MACCE to 41 patients (8.2%). Patients treated with a provisional single stent had significantly lower rates of cardiac hospital admission and MACCE compared with double stenting (1 [0.7%] vs 32 [9%]; P=.0403 and 3 [2.1%] vs 70 [20%]; P=.0054, respectively). Conclusion: PCI with drug-eluting stents for ULMCAD was safe and effective, with favorable long-term outcomes in patients who were unfit for surgery or refused surgery. The provisional single-stent technique demonstrated better clinical outcomes than the double-stent approach. https://jthc.tums.ac.ir/index.php/jthc/article/view/2336 https://jthc.tums.ac.ir/index.php/jthc/article/download/2336/1271