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Trends in Clinical Practice and Outcomes After Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery

Mohammad, Moman A. LU ; Persson, Jonas ; Buccheri, Sergio ; Odenstedt, Jacob ; Sarno, Giovanna ; Angerås, Oskar ; Völz, Sebastian ; Tödt, Tim LU ; Götberg, Matthias LU and Isma, Nazim LU , et al. (2022) In Journal of the American Heart Association 11(7).
Abstract

BACKGROUND: The use of percutaneous coronary intervention (PCI) to treat unprotected left main coronary artery disease has expanded rapidly in the past decade. We aimed to describe nationwide trends in clinical practice and outcomes after PCI for left main coronary artery disease. METHODS AND RESULTS: Patients (n=4085) enrolled in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) as undergoing PCI for left main coronary artery disease from 2005 to 2017 were included. A count regression model was used to analyze time-related differences in procedural characteristics. The 3-year major adverse cardiovascular and cerebrovascular event rate defined as death, myocardial infarction, stroke, and repeat revascularization was... (More)

BACKGROUND: The use of percutaneous coronary intervention (PCI) to treat unprotected left main coronary artery disease has expanded rapidly in the past decade. We aimed to describe nationwide trends in clinical practice and outcomes after PCI for left main coronary artery disease. METHODS AND RESULTS: Patients (n=4085) enrolled in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) as undergoing PCI for left main coronary artery disease from 2005 to 2017 were included. A count regression model was used to analyze time-related differences in procedural characteristics. The 3-year major adverse cardiovascular and cerebrovascular event rate defined as death, myocardial infarction, stroke, and repeat revascularization was calculated with the KaplanMeier estimator and Cox proportional hazard model. The number of annual PCI procedures grew from 121 in 2005 to 589 in 2017 (389%). The increase was greater for men (479%) and individuals with diabetes (500%). Periprocedural complications occurred in 7.9%, decreasing from 10% to 6% during the study period. A major adverse cardiovascular and cerebrovascular event occurred in 35.7% of patients, falling from 45.6% to 23.9% (hazard ratio, 0.56; 95% CI, 0.41–0.78; P=0.001). Radial artery access rose from 21.5% to 74.2% and intracoronary diagnostic procedures from 14.0% to 53.3%. Use of bare-metal stents and first-generation drug-eluting stents fell from 19.0% and 71.9%, respectively, to 0, with use of new-generation drugeluting stents increasing to 95.2%. CONCLUSIONS: Recent changes in clinical practice relating to PCI for left main coronary artery disease are characterized by a 4-fold rise in procedures conducted, increased use of evidence-based adjunctive treatment strategies, intracoronary diagnostics, newer stents, and more favorable outcomes.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
PCI, unprotected left main coronary artery disease
in
Journal of the American Heart Association
volume
11
issue
7
article number
e024040
publisher
Wiley-Blackwell
external identifiers
  • scopus:85128245373
  • pmid:35350870
ISSN
2047-9980
DOI
10.1161/JAHA.121.024040
language
English
LU publication?
yes
id
52d47589-ec98-4ff6-84fd-36bc781f88d7
date added to LUP
2022-07-06 13:50:39
date last changed
2023-09-10 23:30:48
@article{52d47589-ec98-4ff6-84fd-36bc781f88d7,
  abstract     = {{<p>BACKGROUND: The use of percutaneous coronary intervention (PCI) to treat unprotected left main coronary artery disease has expanded rapidly in the past decade. We aimed to describe nationwide trends in clinical practice and outcomes after PCI for left main coronary artery disease. METHODS AND RESULTS: Patients (n=4085) enrolled in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) as undergoing PCI for left main coronary artery disease from 2005 to 2017 were included. A count regression model was used to analyze time-related differences in procedural characteristics. The 3-year major adverse cardiovascular and cerebrovascular event rate defined as death, myocardial infarction, stroke, and repeat revascularization was calculated with the KaplanMeier estimator and Cox proportional hazard model. The number of annual PCI procedures grew from 121 in 2005 to 589 in 2017 (389%). The increase was greater for men (479%) and individuals with diabetes (500%). Periprocedural complications occurred in 7.9%, decreasing from 10% to 6% during the study period. A major adverse cardiovascular and cerebrovascular event occurred in 35.7% of patients, falling from 45.6% to 23.9% (hazard ratio, 0.56; 95% CI, 0.41–0.78; P=0.001). Radial artery access rose from 21.5% to 74.2% and intracoronary diagnostic procedures from 14.0% to 53.3%. Use of bare-metal stents and first-generation drug-eluting stents fell from 19.0% and 71.9%, respectively, to 0, with use of new-generation drugeluting stents increasing to 95.2%. CONCLUSIONS: Recent changes in clinical practice relating to PCI for left main coronary artery disease are characterized by a 4-fold rise in procedures conducted, increased use of evidence-based adjunctive treatment strategies, intracoronary diagnostics, newer stents, and more favorable outcomes.</p>}},
  author       = {{Mohammad, Moman A. and Persson, Jonas and Buccheri, Sergio and Odenstedt, Jacob and Sarno, Giovanna and Angerås, Oskar and Völz, Sebastian and Tödt, Tim and Götberg, Matthias and Isma, Nazim and Yndigegn, Troels and Tydén, Patrik and Venetsanos, Dimitrios and Birgander, Mats and Olivecrona, Göran K.}},
  issn         = {{2047-9980}},
  keywords     = {{PCI; unprotected left main coronary artery disease}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{7}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{Trends in Clinical Practice and Outcomes After Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery}},
  url          = {{http://dx.doi.org/10.1161/JAHA.121.024040}},
  doi          = {{10.1161/JAHA.121.024040}},
  volume       = {{11}},
  year         = {{2022}},
}