In-hospital outcomes of ad hoc versus planned PCI for unprotected left-main disease: An analysis of 8574 cases from British Cardiovascular Intervention Society database 2006–2018

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-09-05 DOI:10.1002/ccd.31210

Tim Kinnaird MD, Sean Gallagher MD, Vasim Farooq PhD, Majd B. Protty PhD, Hannah Cranch MD, Peader Devlin MD, Andrew Sharp MD, Nick Curzen PhD, Peter Ludman MD, David Hildick-Smith MD, Tom Johnson PhD, Mamas A. Mamas DPhil

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Abstract

Background

Although data suggests ad hoc percutaneous coronary intervention (PCI) results in similar patient outcomes compared to planned PCI in nonselected patients, data for ad hoc unprotected left main stem PCI (uLMS-PCI) are lacking.

Aim

To determine if in-hospital outcomes of uLMS-PCI vary by ad hoc versus planned basis.

Methods

Data were analyzed from all patients undergoing uLMS-PCI in the United Kingdom 2006–2018, and patients grouped into uLMS-PCI undertaken on an ad hoc or a planned basis. Patients who presented with ST-segment elevation, cardiogenic shock, or with an emergency PCI indication were excluded.

Results

In total, 8574 uLMS-PCI procedures were undertaken with 2837 (33.1%) of procedures performed on an ad hoc basis. There was a lower likelihood of intervention for stable angina (28.8% vs. 53.8%, p < 0.001) and a higher rate of potent P2Y12 inhibitor use (16.4% vs. 12.1%, p < 0.001) in the ad hoc PCI group compared to the planned PCI group. Patients undergoing uLMS-PCI on an ad hoc basis tended to undergo less complex procedures. Acute procedural complications including slow flow (odds ratio [OR]: 1.70, 95% confidence interval [CI]: 1.01–2.86), coronary dissection (OR: 1.41, 95% CI: 1.12–1.77) and shock induction (OR: 2.80, 95% CI: 1.64–4.78) were more likely in the ad hoc PCI group. In-hospital death (OR: 1.65, 95% CI: 1.19–2.27) and in-hospital major adverse cardiac or cerebrovascular events (OR: 1.50, 95% CI: 1.13–1.98) occurred more frequently in the ad hoc group. In sensitivity analyses, these observations did not differ when several subgroups were separately examined.

Conclusions

Ad hoc PCI for uLMS disease is associated with adverse outcomes compared to planned PCI. These data should inform uLMS-PCI procedural planning.

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针对无保护左主干疾病的临时PCI与计划PCI的院内预后：英国心血管介入协会数据库2006-2018年8574例病例分析。

背景：尽管有数据表明，在非选择性患者中，临时性经皮冠状动脉介入治疗（PCI）与计划性PCI相比可获得相似的患者预后，但缺乏临时性无保护左主干PCI（uLMS-PCI）的数据。目的：确定uLMS-PCI的院内预后是否因临时性与计划性而有所不同：方法：对2006-2018年英国所有接受uLMS-PCI的患者数据进行分析，并将患者分为临时性uLMS-PCI和计划性uLMS-PCI两组。排除了ST段抬高、心源性休克或有急诊PCI指征的患者：总共进行了8574例uLMS-PCI手术，其中2837例（33.1%）是临时进行的。对稳定型心绞痛进行介入治疗的可能性较低（28.8% 对 53.8%，P与计划的PCI相比，针对uLMS疾病的临时PCI与不良预后相关。这些数据应为uLMS-PCI程序规划提供参考。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.