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Impact of Intracoronary Imaging‐Guided Percutaneous Coronary Intervention on Procedural Outcomes Among Complex Patient Groups

Mohamed, Mohamed O.; Kinnaird, Tim; Wijeysundera, Harindra C.; Johnson, Thomas W.; Zaman, Sarah; Rashid, Muhammad; Moledina, Saadiq; Ludman, Peter; Mamas, Mamas A.

Impact of Intracoronary Imaging‐Guided Percutaneous Coronary Intervention on Procedural Outcomes Among Complex Patient Groups Thumbnail


Authors

Mohamed O. Mohamed

Tim Kinnaird

Harindra C. Wijeysundera

Thomas W. Johnson

Sarah Zaman

Saadiq Moledina

Peter Ludman



Abstract

Background Intracoronary imaging (ICI) has been shown to improve survival after percutaneous coronary intervention (PCI). Whether this prognostic benefit is sustained across different indications remains unclear. Methods and Results All PCI procedures performed in England and Wales between April, 2014 and March 31, 2020, were retrospectively analyzed. The association between ICI use and in‐hospital major acute cardiovascular and cerebrovascular events; composite of all‐cause mortality, stroke, and reinfarction and mortality was examined using multivariable logistic regression analysis for different imaging‐recommended indications as set by European Association for Percutaneous Cardiovascular Interventions consensus. Of 555 398 PCI procedures, 10.8% (n=59 752) were ICI‐guided. ICI use doubled between 2014 (7.8%) and 2020 (17.5%) and was highest in left main PCI (41.2%) and lowest in acute coronary syndrome (9%). Only specific European Association for Percutaneous Cardiovascular Interventions imaging‐recommended indications were associated with reduced major acute cardiovascular and cerebrovascular events and mortality, including left main PCI (odds ratio [OR], 0.45 [95% CI, 0.39–0.52] and 0.41 [95% CI, 0.35–0.48], respectively), acute coronary syndrome (OR, 0.76 [95% CI, 0.70–0.82] and 0.70 [95% CI, 0.63–0.77]), and stent length >60 mm (OR, 0.75 [95% CI, 0.59–0.94] and 0.72 [95% CI, 0.54–0.95]). Stent thrombosis and renal failure were associated with lower mortality (OR, 0.69 [95% CI, 0.52–0.91]) and major acute cardiovascular and cerebrovascular events (OR, 0.77 [95% CI, 0.60–0.99]), respectively. Conclusions ICI use has more than doubled over a 7‐year period at a national level but remains low, with <1 in 5 procedures performed under ICI guidance. In‐hospital survival was better with ICI‐guided than angiography‐guided PCI, albeit only for specific indications.

Citation

Mohamed, M. O., Kinnaird, T., Wijeysundera, H. C., Johnson, T. W., Zaman, S., Rashid, M., …Mamas, M. A. (2022). Impact of Intracoronary Imaging‐Guided Percutaneous Coronary Intervention on Procedural Outcomes Among Complex Patient Groups. Journal of the American Heart Association, 11(19), 1-17. https://doi.org/10.1161/jaha.122.026500

Journal Article Type Article
Acceptance Date Aug 5, 2022
Online Publication Date Sep 29, 2022
Publication Date Oct 4, 2022
Publicly Available Date May 30, 2023
Journal Journal of the American Heart Association
Publisher Wiley Open Access
Peer Reviewed Peer Reviewed
Volume 11
Issue 19
Article Number e026500
Pages 1-17
DOI https://doi.org/10.1161/jaha.122.026500
Public URL https://keele-repository.worktribe.com/output/424439
Publisher URL https://www.ahajournals.org/doi/10.1161/JAHA.122.026500