Author + information
- Received September 3, 2019
- Revision received September 25, 2019
- Accepted October 1, 2019
- Published online February 3, 2020.
- Tim Kinnaird, MDa,b,∗ (, )
- Thomas Johnson, PhDc,
- Richard Anderson, MDa,
- Sean Gallagher, MDa,
- Alex Sirker, PhDd,
- Peter Ludman, MDe,
- Mark de Belder, MDf,
- Samuel Copt, PhDg,
- Keith Oldroyd, MDh,
- Adrian Banning, MDi,
- Mamas Mamas, DPhila,j and
- Nick Curzen, PhDk
- aDepartment of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
- bKeele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- cDepartment of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
- dBarts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- eInstitute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
- fDepartment of Cardiology, James Cook University Hospital, Middlesbrough, United Kingdom
- gDivision of Statistics, Biosensors SA, Morges, Switzerland
- hDepartment of Cardiology, Golden Jubilee Hospital, Glasgow, United Kingdom
- iDepartment of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
- jDepartment of Cardiology, Royal Stoke Hospital, University Hospitals of the North Midlands, Stoke-on-Trent, United Kingdom
- kDepartment of Cardiology, University Hospital NHS Trust, Southampton, United Kingdom
- ↵∗Address for correspondence:
Dr. Tim Kinnaird, Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
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.
- 12-month survival
- intravascular ultrasound
- left main artery
- national database
- optical coherence tomography
- percutaneous coronary intervention
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.
- Received September 3, 2019.
- Revision received September 25, 2019.
- Accepted October 1, 2019.
- 2020 American College of Cardiology Foundation
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