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Intracoronary imaging guided percutaneous coronary intervention outcomes among individuals with cardiogenic shock

Mohamed, Mohamed O.; Kinnaird, Tim; Rab, Syed Tanveer; Zaman, Sarah; Banerjee, Amitava; Sirker, Alex; Mintz, Gary; Mamas, Mamas A.

Authors

Mohamed O. Mohamed

Tim Kinnaird

Syed Tanveer Rab

Sarah Zaman

Amitava Banerjee

Alex Sirker

Gary Mintz



Abstract

Background: Limited data exist around the utility of intracoronary imaging (ICI) during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and cardiogenic shock (CS), who are inherently at a high risk of stent thrombosis (ST).

Methods: All PCI procedures for ACS patients with CS in England and Wales between 2014 and 2020 were retrospectively analysed, stratified into two groups: ICI and angiography‐guided groups. Multivariable logistic regression analyses were performed to examine odds ratios (OR) of in‐hospital outcomes, including major adverse cardiovascular and cerebrovascular events (MACCE; composite of all‐cause mortality, acute stroke/transient ischaemic attack (TIA), and reinfarction) and major bleeding, in the ICI‐guided group compared with angiography‐guided PCI.

Results: Of 15,738 PCI procedures, 1240(7.9%) were ICI‐guided. The rate of ICI use amongst those with CS more than doubled from 2014 (5.7%) to 2020 (13.3%). The ICI‐guided group were predominantly younger, males, with a higher proportion of non‐ST‐elevation ACS and ST. MACCE was significantly lower in the ICI‐guided group compared with the angiography‐guided group (crude: 29.8% vs. 38.2%, adjusted odds ratio (OR) 0.65 95% confidence interval [CI] 0.56–0.76), driven by lower all‐cause mortality (28.6% vs. 37.0%, OR 0.65 95% CI 0.55–0.75). There were no differences in other secondary outcomes between groups.

Conclusion: ICI use among CS patients has more than doubled over 6 years but remains significantly under‐utilized, with less than 1‐in‐6 patients in receipt of ICI‐guided PCI by 2020. ICI‐guided PCI is associated with prognostic benefits in CS patients and should be more frequently utilized to increase their long‐term survival.

Journal Article Type Article
Acceptance Date Oct 5, 2023
Online Publication Date Oct 23, 2023
Deposit Date Oct 30, 2023
Publicly Available Date Oct 30, 2023
Journal Catheterization and Cardiovascular Interventions
Print ISSN 1522-1946
Electronic ISSN 1522-726X
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 102
Issue 6
Pages 1004-1011
DOI https://doi.org/10.1002/ccd.30859
Keywords intravascular imaging, OCT, IVUS, outcomes, cardiogenic shock

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Copyright Statement
This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.







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