Temporal Trends in In-Hospital Outcomes Following Unprotected Left-Main Percutaneous Coronary Intervention: An
Tim Kinnaird1,2, Sean Gallagher1, Vasim Farooq1
1Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.).
Insights
Outcomes for unprotected left main stem percutaneous coronary intervention (PCI) have improved despite increasing patient complexity. This study found significant reductions in major adverse cardiac events and procedural complications over time.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- Unprotected left main stem percutaneous intervention (PCI) is a growing treatment for left main stem artery disease.
- Uncertainty exists regarding temporal trends in patient outcomes following this procedure.
Purpose of the Study:
- To evaluate changes in patient demographics, procedural complexity, and in-hospital outcomes for unprotected left main stem PCI over a 9-year period.
- To identify factors associated with improved outcomes in this patient population.
Main Methods:
- Analysis of the United Kingdom national PCI database from 2009 to 2017.
- Inclusion of patients undergoing unprotected left main stem PCI, excluding those with ST-segment-elevation myocardial infarction, cardiogenic shock, or emergency indications.
- Statistical analysis to assess temporal trends and multivariable analysis to identify outcome predictors.
Main Results:
- Over 14,500 procedures were analyzed, showing increased patient age and comorbidity burden over time.
- Procedural complexity significantly increased, with greater use of multiple stents, bifurcation techniques, and intravascular imaging.
- Significant temporal reductions were observed in peri-procedural myocardial infarction, in-hospital major adverse cardiac or cerebrovascular events, and acute procedural complications.
- Use of intravascular imaging and the year of PCI were associated with lower rates of in-hospital major adverse cardiac or cerebrovascular events.
Conclusions:
- Despite rising patient and procedural complexity, in-hospital outcomes after unprotected left main stem PCI have demonstrably improved.
- These improvements highlight advancements in interventional cardiology techniques and technology for treating complex coronary artery disease.
Background:
Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main stem artery (unprotected left main stem percutaneous intervention) disease. However, whether patient outcomes have improved over time is uncertain.
Methods:
Using the United Kingdom national PCI database, we studied all patients undergoing unprotected left main stem percutaneous intervention between 2009 and 2017. We excluded patients who presented with ST-segment-elevation, cardiogenic shock, and with an emergency indication for PCI.
Results:
Between 2009 and 2017, in the study-indicated population, 14 522 unprotected left main stem percutaneous intervention procedures were performed. Significant temporal changes in baseline demographics were observed with increasing patient age and comorbid burden. Procedural complexity increased over time, with the number of vessels treated, bifurcation PCI, number of stents used, and use of intravascular imaging and rotational atherectomy increased significantly through the study period. After adjustment for baseline differences, there were significant temporal reductions in the occurrence of peri-procedural myocardial infarction (P<0.001 for trend), in-hospital major adverse cardiac or cerebrovascular events (P<0.001 for trend), and acute procedural complications (P<0.001 for trend). In multivariable analysis examining the associates of in-hospital major adverse cardiac or cerebrovascular events, while age per year (odds ratio, 1.02 [95% CIs, 1.01-1.03]), female sex (odds ratio, 1.47 [1.19-1.82]), 3 or more stents (odds ratio, 1.67 [05% [1.02-2.67]), and patient comorbidity were associated with higher rates of in-hospital major adverse cardiac or cerebrovascular events, by contrast use of intravascular imaging (odds ratio, 0.56 [0.45-0.70]), and year of PCI (odds ratio, 0.63 [0.46-0.87]) were associated with lower rates of in-hospital major adverse cardiac or cerebrovascular events.
Conclusions:
Despite trends for increased patient and procedural complexity, in-hospital patient outcomes have improved after unprotected left main stem percutaneous intervention over time.
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