Tesis

Perbandingan Hasil Intervensi Koroner Perkutan Secara Angiografi Pada Arteri Koroner Left Main di Institusi dengan Frekuensi Pencitraan Intrakoroner Tinggi dan Rendah = Comparison of Left Main Coronary Artery Outcomes Following Angiography-Guided Percutaneous Coronary Intervention in High- and Low Frequency Intracoronary Imaging Utilization.

Latar Belakang: Intervensi Koroner Perkutan (IKP) pada lesi Left Main (LM) merupakan salah satu tindakan IKP kompleks yang direkomendasikan menggunakan panduan pencitraan intrakoroner untuk mendapatkan hasil yang baik. Namun, penggunaan pencitraan intrakoroner secara global masih rendah karena keterbatasan seperti biaya, ketersediaan alat, dan kurangnya operator terlatih. Variasi penggunaan pencitraan intrakoroner antar rumah sakit juga signifikan, dengan sebagian besar institusi masih mengandalkan panduan angiografi. Belum ada penelitian sebelumnya yang membandingan hasil IKP LM-LAD secara provisional dengan panduan angiografi antara institusi dengan frekuensi pencitraan intrakoroner tinggi dan rendah. Tujuan : Mengetahui perbedaan hasil akhir ukuran LM-LAD secara angiografi koroner kuantitatif (QCA) antara institusi frekuensi pencitraan intrakoroner tinggi dan rendah. Metode: Penelitian ini menggunakan desain cross-sectional analitik dengan sampel 110 pasien yang menjalani IKP LM dengan teknik provisional LM-LAD dan panduan angiografi. Sampel terdiri dari 59 pasien dari institusi dengan frekuensi pencitraan intrakoroner tinggi dan 51 pasien dari institusi rendah. Pengukuran diameter LM dilakukan menggunakan Quantitative Coronary Angiography (QCA) khusus bifurkasi, dengan target ukuran diameter = diameter referensi + adjusted QCA (5-10%) sesuai rekomendasi European Bifurcation Club (EBC) berdasarkan GUIDE DES trial. Hasil dikategorikan sebagai "ya" jika sesuai dengan adjusted QCA dan "tidak" jika tidak sesuai. Hasil: Dari 110 sampel, 19 pasien (17,3%) tidak mencapai target diameter sesuai adjusted QCA, dengan 5 pasien (8,5%) dari institusi frekuensi tinggi dan 14 pasien (27,5%) dari institusi frekuensi rendah (p = 0,013). Analisis multivariat menunjukkan bahwa tindakan Proximal Optimization Technique (POT) secara signifikan berhubungan dengan hasil diameter LM-LAD yang sesuai dengan adjusted QCA (p = 0,004). Tidak ada perbedaan signifikan dalam kesintasan terhadap Kejadian Kardiovaskular Mayor (KKM) antara kedua institusi selama 12 bulan pasca IKP. Kesimpulan: Hasil akhir diameter LM-LAD paska IKP provisional dengan panduan angiografi lebih baik secara kuantitatif sesuai adjusted QCA pada institusi dengan frekuensi pencitraan intrakoroner tinggi dibanding institusi pencitraan intrakoroner rendah.
Kata Kunci: Intervensi koroner perkutan, left main, teknik provisional, adjusted QCA


Background : Percutaneous Coronary Intervention (PCI) for left main (LM) lesions is considered a complex procedure, for which intravascular imaging guidance is recommended to achieve optimal outcomes. However, the global utilization of intravascular imaging remains low due to limitations such as cost, availability, and a lack of trained operators. There is also significant variation in the use of IVUS across hospitals, with many institutions still relying primarily on angiographic guidance. To date, no prior studies have compared the outcomes of provisional PCI for LM-LAD lesions guided by angiography between institutions with high and low frequencies of intravascular imaging utilization. Objective : To determine the differences in final LM-LAD dimensions based on quantitative coronary angiography (QCA) between institutions with high and low frequencies of intravascular imaging utilization. Methode : This study employed an analytical cross-sectional design with a sample of 110 patients who underwent PCI for LM-LAD lesions using the provisional stenting technique with angiography guided. The sample consisted of 59 patients from institutions with a high frequency of intravascular imaging utilization and 51 patients from institutions with a low frequency. LM-LAD diameter measurements were performed using bifurcation-dedicated Quantitative Coronary Angiography (QCA), with the target diameter defined as the reference diameter plus adjusted QCA (5– 10%), as recommended by the European Bifurcation Club (EBC) based on the GUIDE DES trial. The outcomes were categorized as "yes" if they met the adjusted QCA criteria and "no" if they did not. Result : Of the 110 samples, 19 patients (17.3%) did not achieve the target diameter as defined by the adjusted QCA, including 5 patients (8.5%) from institutions with highfrequency intravascular imaging utilization and 14 patients (27.5%) from institutions with low-frequency utilization (p = 0.013). Multivariate analysis demonstrated that the use of the Proximal Optimization Technique (POT) was significantly associated with achieving the target LM-LAD diameter according to adjusted QCA (p = 0.004). There was no significant difference in survival regarding Major Adverse Cardiovascular Events (MACE) between the two institutions over the 12-month follow-up period after PCI. Conclusion : The final diameter of the LM-LAD after provisional PCI guided by angiography is quantitatively better according to adjusted QCA in institutions with a high frequency of intracoronary imaging compared to institutions with a low frequency of intracoronary imaging.
Keywords : Percutaneous coronary intervention, left main, provisional stenting, adjusted quantitative coroangiography.