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Intracoronary Imaging of Proximal Coronary Artery Lesions - A Nationwide Lesion-Level Analysis From SCAAR
Sacharias von Koch1, Sofia Bergman1, Pontus Andell2
1Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
Insights
Intracoronary imaging during percutaneous coronary intervention (PCI) for proximal coronary lesions, including the left main coronary artery (LMCA), significantly reduces repeat revascularization and improves survival. This technique enhances patient outcomes in complex coronary interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Intracoronary imaging use in left main coronary artery (LMCA) percutaneous coronary intervention (PCI) is linked to reduced mortality.
- Data on intracoronary imaging's role in non-LMCA proximal coronary artery lesions is limited.
- This study investigates intracoronary imaging's impact on outcomes for proximal lesions treated with PCI.
Purpose of the Study:
- To evaluate the association between intracoronary imaging use and patient outcomes in proximal coronary artery lesions undergoing PCI.
- To compare target lesion revascularization, all-cause mortality, and stent thrombosis rates between lesions treated with and without intracoronary imaging.
Main Methods:
- Utilized the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) data from June 2013 to January 2021.
- Matched proximal coronary artery lesions (LMCA, LAD, LCx, RCA) assessed with intracoronary imaging to angiography-alone controls using propensity score matching.
- Primary endpoint: target lesion revascularization; Secondary endpoints: all-cause mortality and definite stent thrombosis within 3 years.
Main Results:
- Among 3623 matched pairs, intracoronary imaging use showed a significant reduction in target lesion revascularization (3.7% vs. 4.7%, HR 0.77, P=.025).
- Intracoronary imaging was associated with significantly lower all-cause mortality (9.1% vs. 12.8%, HR 0.70, P<.001).
- No significant difference was observed in definite stent thrombosis between the groups.
Conclusions:
- Intracoronary imaging in proximal coronary artery lesions is associated with decreased rates of repeat revascularization and improved survival.
- The positive impact appears largely driven by outcomes in left main coronary artery (LMCA) lesions.
- These findings support the routine use of intracoronary imaging for assessing and treating proximal coronary lesions.
Background:
Current evidence suggests that use of intracoronary imaging during percutaneous coronary intervention (PCI) of the left main coronary artery (LMCA) reduces mortality. However, there is a scarcity of data on the overall role of intracoronary imaging, particularly in other non-LMCA proximal coronary artery lesions. We aimed to investigate the association of use of intracoronary imaging on outcome in proximal lesions treated with PCI.
Methods:
The Swedish Coronary Angiography and Angioplasty Registry was used to identify all proximal coronary artery lesions treated with stent implantation between June 11, 2013, and January 16, 2021. Proximal coronary artery lesions (LMCA, proximal left anterior descending artery, left circumflex artery, and right coronary artery) assessed by intracoronary imaging before and/or after stent implantation were matched to control lesions treated based on angiography alone using propensity score matching. The primary end point was target lesion revascularization with PCI, and secondary end points included all-cause mortality and definite stent thrombosis within 3 years.
Results:
Among the 3623 matched pairs, intracoronary imaging was associated with significantly lower risk of target lesion revascularization, 3.7% vs 4.7%; hazard ratio (HR), 0.77; 95% CI, 0.61-0.97; P = .025, and all-cause mortality, 9.1% vs 12.8%; HR, 0.70; 95% CI, 0.61-0.81; P < .001, with no difference in definite stent thrombosis.
Conclusions:
The use of intracoronary imaging in proximal coronary artery lesions is associated with lower rates of repeat revascularization and better survival. The results appear to be primarily driven by improved outcome of LMCA lesions. These results reinforce the role of intracoronary imaging in assessing and treating proximal coronary lesions.
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