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

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 calculated with the Kaplan‐Meier 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 drug‐eluting 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.

Temporal Trends in In-Hospital Outcomes Following Unprotected Left-Main Percutaneous Coronary Intervention: An Analysis of 14 522 Cases From British Cardiovascular Intervention Society Database 2009 to 2017

“…16 Similarly, in an analysis of 4085 uLMS-PCI cases from the Swedish Coronary Angiography and Angioplasty Registry (2005-2017), the 3-year major adverse cardiovascular and cerebrovascular event fell from 45.6% to 23.9% over the study period. 17 However, the current study is much larger than any other previous…”

“…16 Similarly, in an analysis of 4085 uLMS-PCI cases from the Swedish Coronary Angiography and Angioplasty Registry (2005–2017), the 3-year major adverse cardiovascular and cerebrovascular event fell from 45.6% to 23.9% over the study period. 17 However, the current study is much larger than any other previous study of uLMS-PCI outcome trends, reports procedures from a more contemporary time frame, and is the first analysis of uLMS-PCI outcomes in the “CHIP-indicated” population. The exclusion of patients with an emergency indication is important as a non-selected study population outcomes are likely to be heavily skewed by high event rates in the small subset of emergency patients.…”

A Cohort Study of the Effects of Integrated Medical and Nursing Rounds Combined with AIDET Communication Mode on Recovery and Quality of Life in Patients Undergoing Percutaneous Coronary Intervention

“…Therefore, the implementation of medical and nursing integration model in general hospitals is an effective means to realize the sustainable development strategy of nursing management. Related studies pointed out that self-care ability is the premise and basis of carrying out the above-mentioned activities, such as self-examination of symptoms and signs, taking medicine according to doctor's advice, healthy diet, and proper exercise after PCI [44]. The implementation of AIDER communication mode nursing in multiple departments can improve patients' experience, relieve anxiety, and harmonize nurse-patient relationship.…”

Is Percutaneous Coronary Intervention Now the Default Revascularization Strategy for Unprotected Left Main Coronary Artery Stenosis?

“…Reports of those who underwent CABG in the contemporary era show 30‐day mortality ranges 3% to 4.2% and the survival at 2 years is ≈95%. 13 While a nearly 40% decrease in peri‐procedural complications and 3‐year major adverse cardiovascular and cerebrovascular events risk between 2005 and 2017 reported by the authors is reassuring, 12 it is conceivable that outcomes with CABG could have been superior in some patients, especially in those with high complexity LMCA stenosis and in those with diabetes.…”

“…In this issue of the Journal of the American Heart Association ( JAHA ), Mohammad et al, describe nationwide trends in clinical practice and outcomes after PCI for LMCA in Sweden. 12 The authors report a 4‐fold rise in LMCA PCI procedures conducted nationally, increased use of evidence‐based adjunctive treatment strategies, intracoronary diagnostics, newer stents, and improved outcomes. The shift towards PCI for LMCA disease in this national registry reflects the trend of LMCA revascularization not just in Sweden but likely in most areas in the world.…”