Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom.
JACC Cardiovasc Interv. 2020 Feb 10;13(3):346-357. doi: 10.1016/j.jcin.2019.10.007.
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.
Limited registry data support the use of intravascular imaging during uLMS PCI to improve outcomes.
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.
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.
The observed lower mortality with use of intravascular imaging to guide uLMS PCI justifies the undertaking of a large-scale randomized trial.
作者利用英国心血管介入学会（BCIS）全国经皮冠状动脉介入治疗（PCI）数据库，探讨在非保护左主干 PCI（uLMS PCI）中使用血管内影像学的时间变化，确定影像学使用的相关因素，并将临床结果（包括生存）与影像学使用相关联。
有限的注册数据支持在 uLMS PCI 中使用血管内影像学来改善结果。
对 2007 年至 2014 年间在英格兰和威尔士进行的 11264 例 uLMS PCI 手术进行数据分析。多变量逻辑回归用于确定影像学使用的相关因素。倾向评分匹配创建了有和没有影像学的 5056 对患者，并进行逻辑回归以量化影像学与结果之间的关联。进行多变量逻辑回归以确定 12 个月死亡率的独立预测因素。
影像学使用率从 2007 年的 30.2%增加到 2014 年的 50.2%（趋势 p<0.001）。与影像学使用相关的因素包括稳定型心绞痛表现（比值比 [OR]：1.200；95%置信区间 [CI]：1.147 至 1.246；p<0.001）、分叉左主干病变（OR：1.220；95%CI：1.140 至 1.300；p<0.001）、既往 PCI（OR：1.320；95%CI：1.200 至 1.440；p<0.001）和桡动脉入路（OR：1.266；95%CI：1.217 至 1.317；p<0.001）。较低的冠状动脉并发症发生率、较低的院内主要不良心脏事件发生率（OR：0.470；95%CI：0.37 至 0.590；p<0.001）和改善的 30 天（OR：0.540；95%CI：0.43 至 0.680；p<0.001）和 12 个月（OR：0.660；95%CI：0.57 至 0.770；p<0.001）死亡率与影像学使用有关，而与无影像学使用相比。随着术者左主干 PCI 量的增加，死亡率降低幅度更大。在逻辑回归模型中，影像学使用与 12 个月的生存率提高相关。
在指导 uLMS PCI 中使用血管内影像学观察到较低的死亡率支持进行大规模随机试验。
