Focus on Left Main
Intravascular Imaging and 12-Month Mortality After Unprotected Left Main Stem PCI: An Analysis From the British Cardiovascular Intervention Society Database

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Abstract

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.

Key Words

12-month survival
intravascular ultrasound
left main artery
national database
optical coherence tomography
percutaneous coronary intervention

Abbreviations and Acronyms

BCIS
British Cardiovascular Intervention Society
CABG
coronary artery bypass grafting
CI
confidence interval
IVUS
intravascular ultrasound
LAD
left anterior descending artery
LMS
left main stem
MACCE
major adverse cardiac or cerebrovascular events
MI
myocardial infarction
OCT
optical coherence tomography
OR
odds ratio
PCI
percutaneous coronary intervention
uLMS
unprotected left main stem

Cited by (0)

Dr. Banning has received institutional research grant support from Boston Scientific; and has received speaker fees from Abbott and Boston Scientific. Dr. Curzen received unrestricted research grants from Boston Scientific, Haemonetics, HeartFlow, Beckman Coulter; has received speaker fees or consultancy fees from Haemonetics, Abbott Vascular, HeartFlow, and Boston Scientific; and has received travel sponsorship from Biosensors, Abbott, Lilly/Daiichi-Sankyo, St. Jude Medical, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.