Keele Research Repository

Background: Limited registry data supports the use of intravascular imaging during unprotected left main-stem PCI (uLMS-PCI) to improve outcomes. We used the BCIS national PCI database to explore temporal changes in the use of intravascular imaging for uLMS-PCI, defined the associates of imaging use, and correlate clinical outcomes including survival with imaging use.

Methods: Data were analysed 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 performed to quantify the association between imaging and outcomes. Multivariate logistic regression to identify the independent predictors of 12-month mortality was performed.

Results: Imaging use increased from 30.2% in 2007 to 50.2% in 2014 (p<0.001 for trend). The factors associated with imaging use included stable angina presentation (OR 1.20, 95% confidence interval [1.147:1.246)], p<0.001), bifurcation LMS disease (OR 1.22 [1.14:1.30], p<0.001), previous PCI (OR 1.32 [1.20:1.44], p<0.001), and radial access (OR 1.266 [1.217:1.317], p<0.001). A lower rate of coronary complications, lower in-hospital MACE (OR 0.47 [0.37:0.59], p<0.001), and improved 30-day mortality (OR 0.54 [0.43:0.68], p<0.001) and 12-month mortality (OR 0.66 [0.57:0.77], p<0.001) were observed with imaging use compared to no imaging use. Greater mortality reductions were observed with higher operator LMS-PCI volume. In logistic regression modelling, imaging use was associated with improved 12-month survival.

Conclusions: The observed lower mortality with use of intravascular imaging to guide uLMS-PCI justifies the undertaking of a large-scale randomised trial.