Pontus Andell1, Sofia Karlsson2, Moman A Mohammad2, Matthias Götberg2, Stefan James2, Jens Jensen2, Ole Fröbert2, Oskar Angerås2, Johan Nilsson2, Elmir Omerovic2, Bo Lagerqvist2, Jonas Persson2, Sasha Koul2, David Erlinge2. 1. From the Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Sweden (P.A., S.K., M.A.M., M.G., S.K., D.E.); Department of Medical Sciences, Uppsala University, Sweden (S.J., B.L.); Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Medicine, Capio St Görans Sjukhus, Stockholm, Sweden (J.J.); Department of Cardiology, Faculty of Health, Örebro University, Sweden (O.F.); Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden (O.A., E.O.); University and Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., E.O.); Department of Cardiology, Umeå University Hospital, Heart Centre, Sweden (J.N.); and Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden (J.P.). pontus.andell@med.lu.se. 2. From the Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Sweden (P.A., S.K., M.A.M., M.G., S.K., D.E.); Department of Medical Sciences, Uppsala University, Sweden (S.J., B.L.); Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Medicine, Capio St Görans Sjukhus, Stockholm, Sweden (J.J.); Department of Cardiology, Faculty of Health, Örebro University, Sweden (O.F.); Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden (O.A., E.O.); University and Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., E.O.); Department of Cardiology, Umeå University Hospital, Heart Centre, Sweden (J.N.); and Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden (J.P.).
Abstract
BACKGROUND: Small observational studies have indicated better outcome with intravascular ultrasound (IVUS) guidance when performing unprotected left main coronary artery (LMCA) percutaneous coronary intervention (PCI), but the overall picture remains inconclusive and warrants further investigation. We studied the impact of IVUS guidance on outcome in patients undergoing unprotected LMCA PCI in a Swedish nationwide observational study. METHODS AND RESULTS: Patients who underwent unprotected LMCA PCI between 2005 and 2014 because of stable coronary artery disease or acute coronary syndrome were included from the nationwide SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Of 2468 patients, IVUS guidance was used in 621 (25.2%). The IVUS group was younger (median age, 70 versus 75 years) and had fewer comorbidities but more complex lesions. IVUS was associated with larger stent diameters (median, 4 mm versus 3.5 mm). After adjusting for potential confounders, IVUS was associated with significantly lower occurrence of the primary composite end point of all-cause mortality, restenosis, or definite stent thrombosis (hazard ratio, 0.65; 95% confidence interval, 0.50-0.84) and all-cause mortality alone (hazard ratio, 0.62; 95% confidence interval, 0.47-0.82). In 340 propensity score-matched pairs, IVUS was also associated with significantly lower occurrence of the primary end point (hazard ratio, 0.54; 95% confidence interval, 0.37-0.80). CONCLUSIONS: IVUS was associated with an independent and significant outcome benefit when performing unprotected LMCA PCI. Potential mediators of this benefit include larger and more appropriately sized stents, perhaps translating into lower risk of subsequent stent thrombosis. Although residual confounding cannot be ruled out, our findings indicate a possible hazard when performing unprotected LMCA PCI without IVUS guidance.
BACKGROUND: Small observational studies have indicated better outcome with intravascular ultrasound (IVUS) guidance when performing unprotected left main coronary artery (LMCA) percutaneous coronary intervention (PCI), but the overall picture remains inconclusive and warrants further investigation. We studied the impact of IVUS guidance on outcome in patients undergoing unprotected LMCA PCI in a Swedish nationwide observational study. METHODS AND RESULTS:Patients who underwent unprotected LMCA PCI between 2005 and 2014 because of stable coronary artery disease or acute coronary syndrome were included from the nationwide SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Of 2468 patients, IVUS guidance was used in 621 (25.2%). The IVUS group was younger (median age, 70 versus 75 years) and had fewer comorbidities but more complex lesions. IVUS was associated with larger stent diameters (median, 4 mm versus 3.5 mm). After adjusting for potential confounders, IVUS was associated with significantly lower occurrence of the primary composite end point of all-cause mortality, restenosis, or definite stent thrombosis (hazard ratio, 0.65; 95% confidence interval, 0.50-0.84) and all-cause mortality alone (hazard ratio, 0.62; 95% confidence interval, 0.47-0.82). In 340 propensity score-matched pairs, IVUS was also associated with significantly lower occurrence of the primary end point (hazard ratio, 0.54; 95% confidence interval, 0.37-0.80). CONCLUSIONS: IVUS was associated with an independent and significant outcome benefit when performing unprotected LMCA PCI. Potential mediators of this benefit include larger and more appropriately sized stents, perhaps translating into lower risk of subsequent stent thrombosis. Although residual confounding cannot be ruled out, our findings indicate a possible hazard when performing unprotected LMCA PCI without IVUS guidance.
Authors: Moman A Mohammad; Jonas Persson; Sergio Buccheri; Jacob Odenstedt; Giovanna Sarno; Oskar Angerås; Sebastian Völz; Tim Tödt; Matthias Götberg; Nazim Isma; Troels Yndigegn; Patrik Tydén; Dimitrios Venetsanos; Mats Birgander; Göran K Olivecrona Journal: J Am Heart Assoc Date: 2022-03-30 Impact factor: 6.106
Authors: Majd B Protty; Sean Gallagher; Andrew S P Sharp; Vasim Farooq; Mohaned Egred; Peter O'Kane; Peter Ludman; Mamas A Mamas; Tim Kinnaird Journal: J Interv Cardiol Date: 2022-03-15 Impact factor: 2.279