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Intracoronary Imaging of Proximal Coronary Artery Lesions – A Nationwide Lesion-Level Analysis From SCAAR

von Koch, Sacharias LU orcid ; Bergman, Sofia LU ; Andell, Pontus LU ; Olivecrona, Göran K. LU ; Götberg, Matthias LU ; Omerovic, Elmir ; Fröbert, Ole ; Buccheri, Sergio ; James, Stefan and Koul, Sasha LU , et al. (2023) In Journal of the Society for Cardiovascular Angiography and Interventions 2(3).
Abstract

Background: Current evidence suggests that use of intracoronary imaging during percutaneous coronary intervention (PCI) of the left main coronary artery (LMCA) reduces mortality. However, there is a scarcity of data on the overall role of intracoronary imaging, particularly in other non-LMCA proximal coronary artery lesions. We aimed to investigate the association of use of intracoronary imaging on outcome in proximal lesions treated with PCI. Methods: The Swedish Coronary Angiography and Angioplasty Registry was used to identify all proximal coronary artery lesions treated with stent implantation between June 11, 2013, and January 16, 2021. Proximal coronary artery lesions (LMCA, proximal left anterior descending artery, left... (More)

Background: Current evidence suggests that use of intracoronary imaging during percutaneous coronary intervention (PCI) of the left main coronary artery (LMCA) reduces mortality. However, there is a scarcity of data on the overall role of intracoronary imaging, particularly in other non-LMCA proximal coronary artery lesions. We aimed to investigate the association of use of intracoronary imaging on outcome in proximal lesions treated with PCI. Methods: The Swedish Coronary Angiography and Angioplasty Registry was used to identify all proximal coronary artery lesions treated with stent implantation between June 11, 2013, and January 16, 2021. Proximal coronary artery lesions (LMCA, proximal left anterior descending artery, left circumflex artery, and right coronary artery) assessed by intracoronary imaging before and/or after stent implantation were matched to control lesions treated based on angiography alone using propensity score matching. The primary end point was target lesion revascularization with PCI, and secondary end points included all-cause mortality and definite stent thrombosis within 3 years. Results: Among the 3623 matched pairs, intracoronary imaging was associated with significantly lower risk of target lesion revascularization, 3.7% vs 4.7%; hazard ratio (HR), 0.77; 95% CI, 0.61-0.97; P = .025, and all-cause mortality, 9.1% vs 12.8%; HR, 0.70; 95% CI, 0.61-0.81; P < .001, with no difference in definite stent thrombosis. Conclusions: The use of intracoronary imaging in proximal coronary artery lesions is associated with lower rates of repeat revascularization and better survival. The results appear to be primarily driven by improved outcome of LMCA lesions. These results reinforce the role of intracoronary imaging in assessing and treating proximal coronary lesions.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
intracoronary imaging, intravascular ultrasound, optical coherence tomography, target lesion revascularization
in
Journal of the Society for Cardiovascular Angiography and Interventions
volume
2
issue
3
article number
100597
publisher
Elsevier
external identifiers
  • scopus:85159306610
ISSN
2772-9303
DOI
10.1016/j.jscai.2023.100597
language
English
LU publication?
yes
id
d435f858-87cb-4fab-8060-43671e708aa8
date added to LUP
2023-08-10 14:24:30
date last changed
2024-01-20 00:50:35
@article{d435f858-87cb-4fab-8060-43671e708aa8,
  abstract     = {{<p>Background: Current evidence suggests that use of intracoronary imaging during percutaneous coronary intervention (PCI) of the left main coronary artery (LMCA) reduces mortality. However, there is a scarcity of data on the overall role of intracoronary imaging, particularly in other non-LMCA proximal coronary artery lesions. We aimed to investigate the association of use of intracoronary imaging on outcome in proximal lesions treated with PCI. Methods: The Swedish Coronary Angiography and Angioplasty Registry was used to identify all proximal coronary artery lesions treated with stent implantation between June 11, 2013, and January 16, 2021. Proximal coronary artery lesions (LMCA, proximal left anterior descending artery, left circumflex artery, and right coronary artery) assessed by intracoronary imaging before and/or after stent implantation were matched to control lesions treated based on angiography alone using propensity score matching. The primary end point was target lesion revascularization with PCI, and secondary end points included all-cause mortality and definite stent thrombosis within 3 years. Results: Among the 3623 matched pairs, intracoronary imaging was associated with significantly lower risk of target lesion revascularization, 3.7% vs 4.7%; hazard ratio (HR), 0.77; 95% CI, 0.61-0.97; P = .025, and all-cause mortality, 9.1% vs 12.8%; HR, 0.70; 95% CI, 0.61-0.81; P &lt; .001, with no difference in definite stent thrombosis. Conclusions: The use of intracoronary imaging in proximal coronary artery lesions is associated with lower rates of repeat revascularization and better survival. The results appear to be primarily driven by improved outcome of LMCA lesions. These results reinforce the role of intracoronary imaging in assessing and treating proximal coronary lesions.</p>}},
  author       = {{von Koch, Sacharias and Bergman, Sofia and Andell, Pontus and Olivecrona, Göran K. and Götberg, Matthias and Omerovic, Elmir and Fröbert, Ole and Buccheri, Sergio and James, Stefan and Koul, Sasha and Mohammad, Moman A. and Erlinge, David}},
  issn         = {{2772-9303}},
  keywords     = {{intracoronary imaging; intravascular ultrasound; optical coherence tomography; target lesion revascularization}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{3}},
  publisher    = {{Elsevier}},
  series       = {{Journal of the Society for Cardiovascular Angiography and Interventions}},
  title        = {{Intracoronary Imaging of Proximal Coronary Artery Lesions – A Nationwide Lesion-Level Analysis From SCAAR}},
  url          = {{http://dx.doi.org/10.1016/j.jscai.2023.100597}},
  doi          = {{10.1016/j.jscai.2023.100597}},
  volume       = {{2}},
  year         = {{2023}},
}