Operator Experience and Outcomes After Left Main Percutaneous Coronary Intervention

  • Arun Kanmanthareddy
  • Dixitha Anugula
  • Biswajit Kar
Ischemic Heart Disease (D Mukherjee, Section Editor)
  • 36 Downloads
Part of the following topical collections:
  1. Topical Collection on Ischemic Heart Disease

Abstract

Purpose of Review

This review was performed with the goal of summarizing the role of operator experience in the treatment of severe left main stenosis by percutaneous intervention techniques.

Recent Findings

The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial demonstrated that percutaneous coronary intervention and coronary artery bypass grafting had similar clinical outcomes for severe left main disease. However, PCI of the left main coronary stenosis is considered to be a high-risk intervention because of the large area of myocardium at jeopardy that can quickly cause hemodynamic compromise. Operator experience and familiarity with the use of hemodynamic support devices, plaque modification techniques, and intravascular imaging tools is associated with better clinical outcomes.

Summary

In patients with severe left main stenosis undergoing percutaneous coronary intervention by high-volume operators, the clinical outcomes are superior.

Keywords

Operator experience Left main Percutaneous coronary intervention High-risk intervention Hemodynamic support 

Notes

Compliance with Ethical Standards

Conflict of Interest

Arun Kanmanthareddy, Dixitha Anugula, and Biswajit Kar declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    DeMots H, Rosch J, McAnulty JH, Rahimtoola SH. Left main coronary artery disease. Cardiovasc Clin. 1977;8(2):201–11.PubMedGoogle Scholar
  2. 2.
    Ruparelia N, Chieffo A. Left main percutaneous coronary intervention. Interv Cardiol Clin. 2016;5(2):125–34.  https://doi.org/10.1016/j.iccl.2015.12.001.PubMedGoogle Scholar
  3. 3.
    Lee PH, Ahn JM, Chang M, Baek S, Yoon SH, Kang SJ, et al. Left main coronary artery disease: secular trends in patient characteristics, treatments, and outcomes. J Am Coll Cardiol. 2016;68(11):1233–46.  https://doi.org/10.1016/j.jacc.2016.05.089.CrossRefPubMedGoogle Scholar
  4. 4.
    Ragosta M, Dee S, Sarembock IJ, Lipson LC, Gimple LW, Powers ER. Prevalence of unfavorable angiographic characteristics for percutaneous intervention in patients with unprotected left main coronary artery disease. Catheter Cardiovasc Interv. 2006;68(3):357–62.  https://doi.org/10.1002/ccd.20709.CrossRefPubMedGoogle Scholar
  5. 5.
    •• Makikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet. 2016;388(10061):2743–52.  https://doi.org/10.1016/S0140-6736(16)32052-9. This randomized trial compared percutaneous coronary intervention vs coronary artery bypass grafting for severe left main stenosis and concluded that coronary artery bypass grafting was superior to percutaneous coronary intervention at 5 years. CrossRefPubMedGoogle Scholar
  6. 6.
    •• Stone GW, Sabik JF, Serruys PW, Simonton CA, Genereux P, Puskas J, et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med. 2016;375(23):2223–35.  https://doi.org/10.1056/NEJMoa1610227. This randomized trial compared percutaneous coronary intervention vs coronary artery bypass grafting for severe left main stenosis and concluded that there was no difference between the two treatment arms at 3 years. CrossRefPubMedGoogle Scholar
  7. 7.
    De la Torre Hernandez JM, Garcia Camarero T. Intravascular ultrasound for the diagnosis and treatment of left main coronary artery disease. Interv Cardiol Clin. 2015;4(3):361–81.  https://doi.org/10.1016/j.iccl.2015.02.002.PubMedGoogle Scholar
  8. 8.
    Tian J, Guan C, Wang W, Zhang K, Chen J, Wu Y, et al. Intravascular ultrasound guidance improves the long-term prognosis in patients with unprotected left main coronary artery disease undergoing percutaneous coronary intervention. Sci Rep. 2017;7(1):2377.  https://doi.org/10.1038/s41598-017-02649-5.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ye Y, Yang M, Zhang S, Zeng Y. Percutaneous coronary intervention in left main coronary artery disease with or without intravascular ultrasound: a meta-analysis. PLoS One. 2017;12(6):e0179756.  https://doi.org/10.1371/journal.pone.0179756.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Fan ZG, Gao XF, Li XB, Shao MX, Gao YL, Chen SL, et al. The outcomes of intravascular ultrasound-guided drug-eluting stent implantation among patients with complex coronary lesions: a comprehensive meta-analysis of 15 clinical trials and 8,084 patients. Anatol J Cardiol. 2017;17(4):258–68.  https://doi.org/10.14744/AnatolJCardiol.2016.7461.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Kang SJ, Ahn JM, Song H, Kim WJ, Lee JY, Park DW, et al. Comprehensive intravascular ultrasound assessment of stent area and its impact on restenosis and adverse cardiac events in 403 patients with unprotected left main disease. Circ Cardiovasc Interv. 2011;4(6):562–9.  https://doi.org/10.1161/CIRCINTERVENTIONS.111.964643.CrossRefPubMedGoogle Scholar
  12. 12.
    Murray SW, Stables RH, Hart G, Palmer ND. Defining the magnitude of measurement variability in the virtual histology analysis of acute coronary syndrome plaques. Eur Heart J Cardiovasc Imaging. 2013;14(2):167–74.  https://doi.org/10.1093/ehjci/jes138.CrossRefPubMedGoogle Scholar
  13. 13.
    •• Xu B, Redfors B, Yang Y, Qiao S, Wu Y, Chen J, et al. Impact of operator experience and volume on outcomes after left main coronary artery percutaneous coronary intervention. JACC Cardiovasc Interv. 2016;9(20):2086–93.  https://doi.org/10.1016/j.jcin.2016.08.011. This study demonstrated that operators with greater experience and volumes had better clinical outcomes for left main percutaneous coronary interventions. CrossRefPubMedGoogle Scholar
  14. 14.
    Fujii K, Mintz GS, Kobayashi Y, Carlier SG, Takebayashi H, Yasuda T, et al. Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis. Circulation. 2004;109(9):1085–8.  https://doi.org/10.1161/01.CIR.0000121327.67756.19.CrossRefPubMedGoogle Scholar
  15. 15.
    Schreiber T, Wah Htun W, Blank N, Telila T, Mercado N, Briasoulis A, et al. Real-world supported unprotected left main percutaneous coronary intervention with impella device; data from the USpella registry. Catheter Cardiovasc Interv. 2017;90:576–81.  https://doi.org/10.1002/ccd.26979.CrossRefPubMedGoogle Scholar
  16. 16.
    Sjauw KD, Konorza T, Erbel R, Danna PL, Viecca M, Minden HH, et al. Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry. J Am Coll Cardiol. 2009;54(25):2430–4.  https://doi.org/10.1016/j.jacc.2009.09.018.CrossRefPubMedGoogle Scholar
  17. 17.
    Alkhatib B, Wolfe L, Naidu SS. Hemodynamic support devices for complex percutaneous coronary intervention. Interv Cardiol Clin. 2016;5(2):187–200.  https://doi.org/10.1016/j.iccl.2015.12.004.PubMedGoogle Scholar
  18. 18.
    Kar B, Adkins LE, Civitello AB, Loyalka P, Palanichamy N, Gemmato CJ, et al. Clinical experience with the TandemHeart percutaneous ventricular assist device. Tex Heart Inst J. 2006;33(2):111–5.PubMedPubMedCentralGoogle Scholar
  19. 19.
    O’Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation. 2012;126(14):1717–27.  https://doi.org/10.1161/CIRCULATIONAHA.112.098194.CrossRefPubMedGoogle Scholar
  20. 20.
    Tomasello SD, Boukhris M, Ganyukov V, Galassi AR, Shukevich D, Haes B, et al. Outcome of extracorporeal membrane oxygenation support for complex high-risk elective percutaneous coronary interventions: a single-center experience. Heart Lung. 2015;44(4):309–13.  https://doi.org/10.1016/j.hrtlng.2015.03.005.CrossRefPubMedGoogle Scholar
  21. 21.
    Badheka AO, Patel NJ, Grover P, Singh V, Patel N, Arora S, et al. Impact of annual operator and institutional volume on percutaneous coronary intervention outcomes: a 5-year United States experience (2005–2009). Circulation. 2014;130(16):1392–406.  https://doi.org/10.1161/CIRCULATIONAHA.114.009281.CrossRefPubMedGoogle Scholar
  22. 22.
    Fanaroff AC, Zakroysky P, Dai D, Wojdyla D, Sherwood MW, Roe MT, et al. Outcomes of PCI in relation to procedural characteristics and operator volumes in the United States. J Am Coll Cardiol. 2017;69(24):2913–24.  https://doi.org/10.1016/j.jacc.2017.04.032.CrossRefPubMedGoogle Scholar
  23. 23.
    Toyofuku M, Kimura T, Morimoto T, Hayashi Y, Ueda H, Kawai K, et al. Three-year outcomes after sirolimus-eluting stent implantation for unprotected left main coronary artery disease: insights from the j-Cypher registry. Circulation. 2009;120(19):1866–74.  https://doi.org/10.1161/CIRCULATIONAHA.109.873349.CrossRefPubMedGoogle Scholar
  24. 24.
    Palmerini T, Sangiorgi D, Marzocchi A, Tamburino C, Sheiban I, Margheri M, et al. Ostial and midshaft lesions vs. bifurcation lesions in 1111 patients with unprotected left main coronary artery stenosis treated with drug-eluting stents: results of the survey from the Italian Society of Invasive Cardiology. Eur Heart J. 2009;30(17):2087–94.  https://doi.org/10.1093/eurheartj/ehp223.CrossRefPubMedGoogle Scholar
  25. 25.
    Nguyen-Trong PJ, Martinez Parachini JR, Resendes E, Karatasakis A, Danek BA, Alame A, et al. Procedural outcomes with use of the flash ostial system in aorto-coronary ostial lesions. Catheter Cardiovasc Interv. 2016;88(7):1067–74.  https://doi.org/10.1002/ccd.26613.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Arun Kanmanthareddy
    • 1
  • Dixitha Anugula
    • 2
  • Biswajit Kar
    • 1
    • 3
  1. 1.Division of Cardiovascular MedicineThe University of Texas Health Sciences Center at HoustonHoustonUSA
  2. 2.Division of Internal MedicineCreighton University School of MedicineOmahaUSA
  3. 3.Center for Advanced Heart FailureMemorial Hermann Heart and Vascular InstituteHoustonUSA

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