Percutaneous coronary intervention for left main coronary artery. Temporal trends and long-term outcomes from the all-comer BIA-LM registry.

IF 3.8 3区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Kardiologia polska Pub Date : 2024-01-01 Epub Date: 2024-10-08 DOI:10.33963/v.phj.102774

Emil Julian Dąbrowski, Sławomir Dobrzycki, Paweł Kralisz, Konrad Nowak, Kamil Gugała, Przemysław Prokopczuk, Grzegorz Mężyński, Michał Święczkowski, Łukasz Kuźma, Marcin Kożuch

{"title":"Percutaneous coronary intervention for left main coronary artery. Temporal trends and long-term outcomes from the all-comer BIA-LM registry.","authors":"Emil Julian Dąbrowski, Sławomir Dobrzycki, Paweł Kralisz, Konrad Nowak, Kamil Gugała, Przemysław Prokopczuk, Grzegorz Mężyński, Michał Święczkowski, Łukasz Kuźma, Marcin Kożuch","doi":"10.33963/v.phj.102774","DOIUrl":null,"url":null,"abstract":"Background: Percutaneous coronary intervention (PCI) for the left main coronary artery (LMCA) was endorsed by trials.Aims: This article aimed to assess prognosis and temporal trends in a real-world registry.Methods: In total, 998 patients undergoing LMCA PCI were hospitalized from December 27, 2007 to February 21, 2022. The analysis included mortality predictors, annual and periodic trends assessments (2007-2015 compared to 2015-2022).Results: The median age of patients was 71 years (interquartile range 16); 736 (73.8%) were male, and 448 (51.9%) had multimorbidity (≥3 chronic diseases). Worse prognosis was associated with age ≥75 years (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.17-2.20; P = 0.003), myocardial infarction (HR, 1.47; 95% CI, 1.06-2.04; P = 0.02), previous myocardial infarction (HR, 1.43; 95% CI, 1.07-1.91; P = 0.02), diabetes (HR, 1.38; 95% CI, 1.03-1.84; P = 0.03), atrial fibrillation (HR, 1.74; 95% CI, 1.26-2.39; P = 0.001), chronic obstructive pulmonary disease (HR, 2.01; 95% CI, 1.27-3.20; P = 0.003), and previous stroke (HR, 1.78; 95% CI, 1.17-2.70; P = 0.007). Higher ejection fraction (HR, 0.98; 95% CI, 0.96-0.99; P <0.001 for 1% increase) and intravascular imaging (HR, 0.70; 95% CI, 0.49-1.00; P = 0.047) yielded better outcomes. The rate of LMCA PCI increased from 2.2% in 2008 to 6.9% in 2021 (P <0.001). There were increases in annual and periodic multimorbidity rates (P <0.001), intravascular imaging (P <0.001), and decreases in 30-, 90-day (log-rank P <0.001) and 1-year mortality (log-rank P = 0.007). Six-year landmark mortality analysis at 30 days showed a trend toward worse prognosis in patients hospitalized in the late period (log-rank P = 0.051).Conclusions: PCI and multimorbidity rates increased. Short-term mortality decreased, while prognosis beyond 30 days worsened. Advancements in PCI technology may improve early outcomes; however, efforts should be made to reduce multimorbidity burden.","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":"1247-1258"},"PeriodicalIF":3.8000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kardiologia polska","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.33963/v.phj.102774","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/8 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Percutaneous coronary intervention (PCI) for the left main coronary artery (LMCA) was endorsed by trials.

Aims: This article aimed to assess prognosis and temporal trends in a real-world registry.

Methods: In total, 998 patients undergoing LMCA PCI were hospitalized from December 27, 2007 to February 21, 2022. The analysis included mortality predictors, annual and periodic trends assessments (2007-2015 compared to 2015-2022).

Results: The median age of patients was 71 years (interquartile range 16); 736 (73.8%) were male, and 448 (51.9%) had multimorbidity (≥3 chronic diseases). Worse prognosis was associated with age ≥75 years (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.17-2.20; P = 0.003), myocardial infarction (HR, 1.47; 95% CI, 1.06-2.04; P = 0.02), previous myocardial infarction (HR, 1.43; 95% CI, 1.07-1.91; P = 0.02), diabetes (HR, 1.38; 95% CI, 1.03-1.84; P = 0.03), atrial fibrillation (HR, 1.74; 95% CI, 1.26-2.39; P = 0.001), chronic obstructive pulmonary disease (HR, 2.01; 95% CI, 1.27-3.20; P = 0.003), and previous stroke (HR, 1.78; 95% CI, 1.17-2.70; P = 0.007). Higher ejection fraction (HR, 0.98; 95% CI, 0.96-0.99; P <0.001 for 1% increase) and intravascular imaging (HR, 0.70; 95% CI, 0.49-1.00; P = 0.047) yielded better outcomes. The rate of LMCA PCI increased from 2.2% in 2008 to 6.9% in 2021 (P <0.001). There were increases in annual and periodic multimorbidity rates (P <0.001), intravascular imaging (P <0.001), and decreases in 30-, 90-day (log-rank P <0.001) and 1-year mortality (log-rank P = 0.007). Six-year landmark mortality analysis at 30 days showed a trend toward worse prognosis in patients hospitalized in the late period (log-rank P = 0.051).

Conclusions: PCI and multimorbidity rates increased. Short-term mortality decreased, while prognosis beyond 30 days worsened. Advancements in PCI technology may improve early outcomes; however, efforts should be made to reduce multimorbidity burden.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

经皮冠状动脉介入治疗左冠状动脉主干。所有患者 BIA-LM 登记的时间趋势和长期疗效。

背景：经皮冠状动脉介入治疗（PCI）治疗左主干冠状动脉（LMCA）得到了试验的认可。目的：旨在评估真实世界登记中的预后和时间趋势。分析包括死亡率预测因素、年度和周期趋势（2007-2015 年与 2015-2022 年相比）：中位年龄为71岁（IQR为16），736人（73.8%）为男性，448人（51.9%）患有多种疾病（≥3种慢性病）。预后较差与年龄≥75 岁（HR 1.61，95% CI 1.17-2.20，P=0.003）、心肌梗死（HR 1.47，95% 1.06-2.04，P=0.02）、既往心肌梗死（HR 1.43，95% CI 1.07-1.91，P=0.02）、糖尿病（HR 1.38，95% CI 1.03-1.84，P=0.03）、心房颤动（HR 1.74，95% CI 1.26-2.39，P=0.001）、慢性阻塞性肺病（HR 2.01，95% CI 1.27-3.20，P=0.003）和既往中风（HR 1.78，95% CI 1.17-2.70，P=0.007）。较高的射血分数（HR 0.98，95% CI 0.96-0.99，P=0.007）和曾中风（HR 1.78，95% CI 1.17-2.70，P=0.007）：PCI和多病症发生率增加。短期死亡率下降，而30天后的预后恶化。PCI 技术的进步可能会改善早期预后，但应努力减轻多病负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Kardiologia polska 医学-心血管系统

CiteScore

3.00

自引率

24.20%

发文量

431

审稿时长

3-6 weeks

期刊介绍： Kardiologia Polska (Kardiol Pol, Polish Heart Journal) is the official peer-reviewed journal of the Polish Cardiac Society (PTK, Polskie Towarzystwo Kardiologiczne) published monthly since 1957. It aims to provide a platform for sharing knowledge in cardiology, from basic science to translational and clinical research on cardiovascular diseases.