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Intravascular Imaging and 12-Month Mortality After Unprotected Left Main Stem PCI: An Analysis From the
Tim Kinnaird1, Thomas Johnson2, Richard Anderson3
1Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
Insights
Intravascular imaging use in unprotected left main stem percutaneous coronary intervention (uLMS PCI) increased significantly. Imaging was associated with reduced complications and improved survival, warranting further trials.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Medical device technology
Background:
- Limited data exist on intravascular imaging use during unprotected left main stem percutaneous coronary intervention (uLMS PCI).
- Registry data are crucial for understanding current practices and outcomes in uLMS PCI.
Purpose of the Study:
- To examine trends in intravascular imaging use for uLMS PCI.
- To identify factors associated with imaging use.
- To evaluate the impact of imaging on clinical outcomes, including survival.
Main Methods:
- Analysis of 11,264 uLMS PCI procedures from the BCIS database (2007-2014).
- Multivariate logistic regression to identify predictors of imaging use and outcomes.
- Propensity score matching to compare outcomes between imaging and non-imaging groups.
Main Results:
- Intravascular imaging use rose from 30.2% to 50.2% between 2007 and 2014.
- Imaging use was associated with stable angina, bifurcation LMS disease, prior PCI, and radial access.
- Imaging use correlated with lower coronary complications, in-hospital MACE, and improved 30-day and 12-month mortality.
Conclusions:
- Intravascular imaging is increasingly used in uLMS PCI and is linked to better outcomes.
- The observed survival benefit supports a large-scale randomized trial to confirm these findings.
Objectives:
The authors used the British Cardiovascular Intervention Society (BCIS) national percutaneous coronary intervention (PCI) database to explore temporal changes in the use of intravascular imaging for unprotected left main stem PCI (uLMS PCI), defined the associates of imaging use, and correlate clinical outcomes including survival with imaging use.
Background:
Limited registry data support the use of intravascular imaging during uLMS PCI to improve outcomes.
Methods:
Data were analyzed from 11,264 uLMS PCI procedures performed in England and Wales between 2007 and 2014. Multivariate logistic regression was used to identify associates of imaging use. Propensity matching created 5,056 pairs of subjects with and without imaging and logistic regression was performed to quantify the association between imaging and outcomes. Multivariate logistic regression to identify the independent predictors of 12-month mortality was performed.
Results:
Imaging use increased from 30.2% in 2007 to 50.2% in 2014 (p for trend < 0.001). The factors associated with imaging use included stable angina presentation (odds ratio [OR]: 1.200; 95% confidence interval [CI]: 1.147 to 1.246; p < 0.001), bifurcation LMS disease (OR: 1.220; 95% CI: 1.140 to 1.300; p < 0.001), previous PCI (OR: 1.320; 95% CI: 1.200 to 1.440; p < 0.001), and radial access (OR: 1.266; 95% CI: 1.217 to 1.317; p < 0.001). A lower rate of coronary complications, lower in-hospital major adverse cardiac events (OR: 0.470; 95% CI: 0.37 to 0.590; p < 0.001), and improved 30-day (OR: 0.540; 95% CI: 0.430 to 0.680; p < 0.001) and 12-month (OR: 0.660; 95% CI: 0.570 to 0.770; p < 0.001) mortality were observed with imaging use compared with no imaging use. Greater mortality reductions were observed with higher operator LMS PCI volume. In logistic regression modeling, imaging use was associated with improved 12-month survival.
Conclusions:
The observed lower mortality with use of intravascular imaging to guide uLMS PCI justifies the undertaking of a large-scale randomized trial.