Clinical impact of intravascular ultrasound guidance in drug-eluting stent implantation for unprotected left main coronary disease: pooled analysis at the patient-level of 4 registries
Jose M de la Torre Hernandez, José A Baz Alonso, Joan A Gómez Hospital, Fernando Alfonso Manterola, Tamara Garcia Camarero, Federico Gimeno de Carlos, Gerard Roura Ferrer, Angel Sanchez Recalde, Iñigo Lozano Martínez-Luengas, Josep Gomez Lara, Felipe Hernandez Hernandez, María J Pérez-Vizcayno, Angel Cequier Fillat, Armando Perez de Prado, Agustín Albarrán Gonzalez-Trevilla, Manuel F Jimenez Navarro, Josepa Mauri Ferre, Jose A Fernandez Diaz, Eduardo Pinar Bermudez, Javier Zueco Gil, IVUS-TRONCO-ICP Spanish study, Jose M de la Torre Hernandez, José A Baz Alonso, Joan A Gómez Hospital, Fernando Alfonso Manterola, Tamara Garcia Camarero, Federico Gimeno de Carlos, Gerard Roura Ferrer, Angel Sanchez Recalde, Iñigo Lozano Martínez-Luengas, Josep Gomez Lara, Felipe Hernandez Hernandez, María J Pérez-Vizcayno, Angel Cequier Fillat, Armando Perez de Prado, Agustín Albarrán Gonzalez-Trevilla, Manuel F Jimenez Navarro, Josepa Mauri Ferre, Jose A Fernandez Diaz, Eduardo Pinar Bermudez, Javier Zueco Gil, IVUS-TRONCO-ICP Spanish study
Abstract
Objectives: This study sought to investigate the clinical impact of the use of intravascular ultrasound (IVUS) during revascularization of patients with left main coronary artery (LM) disease with drug-eluting stents (DES).
Background: Whether the use of IVUS during the procedure adds a clinical benefit remains unclear. There is only 1 previous observational study, with relevant limitations, supporting the value of this strategy.
Methods: We performed a patient-level pooled analysis of 4 registries of patients with LM disease treated with DES in Spain. A propensity score-matching method was used to obtain matched pairs of patients with and without IVUS guidance.
Results: A total of 1,670 patients were included, and 505 patients (30.2%) underwent DES implantation under IVUS guidance (IVUS group). By means of the matching method, 505 patients without the use of IVUS during revascularization were selected (no-IVUS group). Survival free of cardiac death, myocardial infarction, and target lesion revascularization at 3 years was 88.7% in the IVUS group and 83.6% in the no-IVUS group (p = 0.04) for the overall population, and 90% and 80.7%, respectively (p = 0.03), for the subgroups with distal LM lesions. The incidence of definite and probable thrombosis was significantly lower in the IVUS group (0.6% vs. 2.2%; p = 0.04). Finally, IVUS-guided revascularization was identified as an independent predictor for major adverse events in the overall population (hazard ratio: 0.70, 95% confidence interval: 0.52 to 0.99; p = 0.04) and in the subgroup with distal lesions (hazard ratio: 0.54, 95% confidence interval: 0.34 to 0.90; p = 0.02).
Conclusions: The results of this pooled analysis show an association of IVUS guidance during percutaneous coronary intervention with better outcomes in patients with LM disease undergoing revascularization with DES.
Keywords: drug-eluting stent(s); intravascular ultrasound; left main coronary artery.
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed