Impact of intravascular imaging on mortality in patients undergoing left main coronary artery PCI. Propensity score matching analysis of the high-volume single centre registry

Abstract Background Recent guidelines endorsed use of intravascular imaging in left main coronary artery (LMCA) percutaneous coronary intervention (PCI). However, impact of adjunctive percutaneous imaging tools on mortality is ambiguous. Purpose The purpose was to investigate impact of intravascular imaging (IVI) on all-cause mortality in patients with LMCA disease. Methods Group of 998 individuals undergoing LMCA PCI was selected from medical records of patients hospitalized in years 2008-2022. Data on mortality were obtained from the Ministry of Digital Affairs. Overall observation time was 14 years (mean 4.3 years). Survival analysis was performed using Cox proportional hazard regression in the overall and propensity-score matched (PSM) population. Results The median age was 71 y.o. (IQR 16), 265 (41.0%) of patients presented with acute myocardial infarction and 183 (20.7%) had history of previous coronary artery bypass grafting (CABG). IVI-guided PCI was performed in 353 (35.4%) patients. In the overall unmatched population, IVI reduced one-year and long-term mortality by 70% (HR 0.3, 95% 0.19-0.47, P<0.001) and 57% (HR 0.43, 95% CI 0.34-0.55, P<0.001). In the subgroup analysis stratified on the history of previous CABG, in patients with unprotected LMCA, IVI resulted in 74% and 63% mortality reduction in the one-year and long-term follow-up (HR 0.26, 95% CI 0.16-0.42, P<0.001; HR 0.37, 95% CI 0.28-0.47, P<0.001; respectively). No influence of IVI on patients with previous CABG was observed. After PSM adjustment for baseline and angiographical characteristics, in the overall population IVI was still associated with significant one-year (HR 0.49, 95% CI 0.25-0.99, P=0.045) and long-term mortality reduction (HR 0.65, 95% CI 0.44-0.97, P=0.03). In patients with unprotected LMCA disease, IVI reduced mortality in two-year observation (HR 0.49, 95% CI 0.26-0.91, P=0.02) and long-term follow-up (HR 0.62, 95% CI 0.41-0.93, P=0.02), with no significant effect in one-year observation. No effect of IVI was observed in the PS-matched cohort of patients with previous CABG. Conclusions Intravascular imaging is associated with significantly better survival in patients undergoing LMCA PCI. The greatest benefit may be obtained in patients with no previous history of CABG. Further studies should investigate subgroups that benefit the most from adjunctive percutaneous tools.PS-matching detailsKaplan-Meier curves in subgroups