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62 Intracoronary imaging in left main stent percutaneous coronary intervention has a clear survival benefit particularly in more complex patients
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  1. Kumail Khan1,
  2. Zaid Ali Abdulelah2,
  3. Sarah Murad3,
  4. Farhan Shahid3,
  5. Sohail Khan3
  1. 1Queen Elizabeth Hospital - University Hospital Birmingham, UK, Kumail Khan, 72 Poole Crescent, Birmingham, WMD B17 0PB, United Kingdom
  2. 2King Hussain Cancer Centre, Amman Jordan
  3. 3Queen Elizabeth Hospital - University Hospital Birmingham, UK

Abstract

Background Left Main Stem Disease (LMS) is prognostically important coronary artery disease that is managed either with coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI). Use of intracoronary imaging (ICI) modalities such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been shown to improve outcomes with PCI revascularization. The primary objective of this study was to evaluate the impact of ICI on outcomes following LMS PCI.

Methods Retrospective observation study of 498 (5.1% of all PCI cases) patients who had undergone LMS PCI at our tertiary primary PCI centre hospital over a 11-year period between July 2010-July 2021. Data was collected from electronic medical records. Follow-up was also obtained through linkage with the Office of National Statistics.

Results The mean age at the time of enrolment was 70.7 ± 11.5 years. Majority of the patients were male 351 (70.5%). 353 (70.9%) of cases had acute coronary syndrome (ACS) presentation while the remainder were elective procedures. Mean follow-up duration was 3.75 ± 3.06 years. Survival calculated by Kaplan Meier was 70%. 87 patients (17.5%) deceased during first year of enrolment. 344 (69.1%) patients had ICI, with IVUS in 316 (63.5%) and OCT in 28 (5.6%) patients. IVUS comprised 91.9% of ICI procedures. Protected LMS (OR 0.175, 95% CI: 0.037–0.833, P-value=0.029) and the use of left ventricular mechanical support device (OR 0.324, 95% CI: 0.122–0.859, P-value=0.024) were associated with decreased odds of undergoing an ICI.Patients undergoing ICI had significantly better survival compared to those without ICI (HR: 0.54, P<0.001). Moreover, OCT showed significantly better survival compared with IVUS (HR: 0.181, P=0.017). Use of ICI was associated with better survival in patients who had Rotablation (HR: 0.455,95% CI: 0.232–0.892, P=0.022), ACS (HR: 0.523, 95% CI: 0.383–0.714, P<0.001) or comorbidities of diabetes and stroke (HR: 0.551, 95% CI: 0.337–0.807, P=0.002).

Conclusion ICI in LMS PCI has a significant survival benefit in our dataset. This is especially the case in patients presenting with ACS, those with comorbidities of Diabetes mellitus and stroke and those undergoing rotablation.

Conflict of Interest No

  • Left main stem (LMS)
  • Percutaneous coronary intervention (PCI)
  • intracoronary imaging (ICI)

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