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Temporal Trends in In-Hospital Outcomes Following Unprotected Left-Main Percutaneous Coronary Intervention: An Analysis of 14 522 Cases From British Cardiovascular Intervention Society Database 2009 to 2017

Kinnaird, Tim; Gallagher, Sean; Farooq, Vasim; Protty, Majd; Back, Liam; Devlin, Peadar; Anderson, Richard; Sharp, Andrew; Ludman, Peter; Copt, Samuel; Mamas, Mamas A.; Curzen, Nick

Authors

Tim Kinnaird

Sean Gallagher

Vasim Farooq

Majd Protty

Liam Back

Peadar Devlin

Richard Anderson

Andrew Sharp

Peter Ludman

Samuel Copt

Nick Curzen



Abstract

Background: Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main stem artery (unprotected left main stem percutaneous intervention) disease. However, whether patient outcomes have improved over time is uncertain. Methods: Using the United Kingdom national PCI database, we studied all patients undergoing unprotected left main stem percutaneous intervention between 2009 and 2017. We excluded patients who presented with ST-segment–elevation, cardiogenic shock, and with an emergency indication for PCI. Results: Between 2009 and 2017, in the study-indicated population, 14 522 unprotected left main stem percutaneous intervention procedures were performed. Significant temporal changes in baseline demographics were observed with increasing patient age and comorbid burden. Procedural complexity increased over time, with the number of vessels treated, bifurcation PCI, number of stents used, and use of intravascular imaging and rotational atherectomy increased significantly through the study period. After adjustment for baseline differences, there were significant temporal reductions in the occurrence of peri-procedural myocardial infarction (P<0.001 for trend), in-hospital major adverse cardiac or cerebrovascular events (P<0.001 for trend), and acute procedural complications (P<0.001 for trend). In multivariable analysis examining the associates of in-hospital major adverse cardiac or cerebrovascular events, while age per year (odds ratio, 1.02 [95% CIs, 1.01–1.03]), female sex (odds ratio, 1.47 [1.19–1.82]), 3 or more stents (odds ratio, 1.67 [05% [1.02–2.67]), and patient comorbidity were associated with higher rates of in-hospital major adverse cardiac or cerebrovascular events, by contrast use of intravascular imaging (odds ratio, 0.56 [0.45–0.70]), and year of PCI (odds ratio, 0.63 [0.46–0.87]) were associated with lower rates of in-hospital major adverse cardiac or cerebrovascular events. Conclusions: Despite trends for increased patient and procedural complexity, in-hospital patient outcomes have improved after unprotected left main stem percutaneous intervention over time.

Citation

Kinnaird, T., Gallagher, S., Farooq, V., Protty, M., Back, L., Devlin, P., …Curzen, N. (2023). Temporal Trends in In-Hospital Outcomes Following Unprotected Left-Main Percutaneous Coronary Intervention: An Analysis of 14 522 Cases From British Cardiovascular Intervention Society Database 2009 to 2017. Circulation: Cardiovascular Interventions, 16(1), Article e012350. https://doi.org/10.1161/CIRCINTERVENTIONS.122.012350

Journal Article Type Article
Acceptance Date Dec 8, 2022
Publication Date Jan 17, 2023
Journal Circulation: Cardiovascular Interventions
Print ISSN 1941-7640
Publisher American Heart Association
Volume 16
Issue 1
Article Number e012350
DOI https://doi.org/10.1161/CIRCINTERVENTIONS.122.012350
Public URL https://keele-repository.worktribe.com/output/426558
Publisher URL https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.122.012350