The University of Southampton
University of Southampton Institutional Repository

Intravascular imaging and 12-month mortality after unprotected left main stem PCI: An analysis From the British Cardiovascular Intervention Society Database

Intravascular imaging and 12-month mortality after unprotected left main stem PCI: An analysis From the British Cardiovascular Intervention Society Database
Intravascular imaging and 12-month mortality after unprotected left main stem PCI: An analysis From the British Cardiovascular Intervention Society Database

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
1936-8798
346-357
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Johnson, Thomas
e122bfc0-cd5a-4a96-8345-05d896a30de4
Anderson, Richard
da4bdca7-6e10-4e0f-9974-aaf9eca8cf8a
Gallagher, Sean
2c8d69a0-9362-4dd2-b5ae-14ef988e5807
Sirker, Alex
906f90ca-feaf-437c-8bf2-fbdaa36e80cb
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
de Belder, Mark
f0106dad-a7dd-4c54-a47e-03ec4c5c826f
Copt, Samuel
32842f37-50b6-476a-88bd-cf186e8bb58c
Oldroyd, Keith
c14c5917-9f7f-46b6-852b-9163add073f7
Banning, Adrian
c4929c3c-bbd4-4d99-8ff0-9b5526162070
Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Curzen, Nicholas
70f3ea49-51b1-418f-8e56-8210aef1abf4
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Johnson, Thomas
e122bfc0-cd5a-4a96-8345-05d896a30de4
Anderson, Richard
da4bdca7-6e10-4e0f-9974-aaf9eca8cf8a
Gallagher, Sean
2c8d69a0-9362-4dd2-b5ae-14ef988e5807
Sirker, Alex
906f90ca-feaf-437c-8bf2-fbdaa36e80cb
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
de Belder, Mark
f0106dad-a7dd-4c54-a47e-03ec4c5c826f
Copt, Samuel
32842f37-50b6-476a-88bd-cf186e8bb58c
Oldroyd, Keith
c14c5917-9f7f-46b6-852b-9163add073f7
Banning, Adrian
c4929c3c-bbd4-4d99-8ff0-9b5526162070
Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Curzen, Nicholas
70f3ea49-51b1-418f-8e56-8210aef1abf4

Kinnaird, Tim, Johnson, Thomas, Anderson, Richard, Gallagher, Sean, Sirker, Alex, Ludman, Peter, de Belder, Mark, Copt, Samuel, Oldroyd, Keith, Banning, Adrian, Mamas, Mamas and Curzen, Nicholas (2020) Intravascular imaging and 12-month mortality after unprotected left main stem PCI: An analysis From the British Cardiovascular Intervention Society Database. JACC Cardiovascular Interventions, 13 (3), 346-357. (doi:10.1016/j.jcin.2019.10.007).

Record type: Article

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.

This record has no associated files available for download.

More information

Accepted/In Press date: 1 October 2019
e-pub ahead of print date: 3 February 2020
Published date: 10 February 2020
Keywords: 12-month survival, intravascular ultrasound, left main artery, national database, optical coherence tomography, percutaneous coronary intervention

Identifiers

Local EPrints ID: 438681
URI: http://eprints.soton.ac.uk/id/eprint/438681
ISSN: 1936-8798
PURE UUID: 1f4f86f9-662a-4d32-a26d-8bbda4a001dc
ORCID for Nicholas Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 20 Mar 2020 17:33
Last modified: 28 Apr 2022 01:55

Export record

Altmetrics

Contributors

Author: Tim Kinnaird
Author: Thomas Johnson
Author: Richard Anderson
Author: Sean Gallagher
Author: Alex Sirker
Author: Peter Ludman
Author: Mark de Belder
Author: Samuel Copt
Author: Keith Oldroyd
Author: Adrian Banning
Author: Mamas Mamas
Author: Nicholas Curzen ORCID iD

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×