BACKGROUND: Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results in bifurcations. We aimed to compare IVUS-guided PCI versus standard PCI in a large registry of patients undergoing PCI for bifurcations in the drug-eluting stent era. METHODS: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 at 22 centers. The primary end-point was the long term rate of major adverse cardiac events [MACE, i.e. death, myocardial infarction or target lesion revascularization (TLR)]. RESULTS: A total of 4,314 patients were included, 226 (5.2%) undergoing IVUS-guided PCI, and 4,088 (94.8%) standard PCI. Early (30-day) outcomes were similar in the two groups, with MACE in 1.3 versus 2.1%, respectively, death in 0.9 versus 1.0%, and stent thrombosis in 0 versus 0.6% (all p > 0.05). After 24 ± 15 months, unadjusted rates of MACE were 17.7 versus 16.4%, with death in 2.7 versus 4.9%, myocardial infarction in 4.4 versus 3.7%, TLR in 15.0 versus 12.3%, and stent thrombosis in 3.1 versus 2.7% (all p > 0.05). Even at multivariable Cox proportional hazard analysis with propensity score adjustment, IVUS was not associated with any statistically significant impact on the risk of MACE, death, myocardial infarction, TLR (neither on the main branch nor on the side branch), or stent thrombosis (all p > 0.05). CONCLUSIONS: Despite a sound rationale to choose stent size, optimize stent expansion and guide kissing inflation, IVUS usage during PCI for coronary bifurcation lesions was not associated with significant clinical benefits in this large retrospective study.
BACKGROUND: Coronary bifurcations remain a challenging lesion subset for percutaneous coronary intervention (PCI). It is unclear whether intravascular ultrasound (IVUS) guidance can improve PCI results in bifurcations. We aimed to compare IVUS-guided PCI versus standard PCI in a large registry of patients undergoing PCI for bifurcations in the drug-eluting stent era. METHODS: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 at 22 centers. The primary end-point was the long term rate of major adverse cardiac events [MACE, i.e. death, myocardial infarction or target lesion revascularization (TLR)]. RESULTS: A total of 4,314 patients were included, 226 (5.2%) undergoing IVUS-guided PCI, and 4,088 (94.8%) standard PCI. Early (30-day) outcomes were similar in the two groups, with MACE in 1.3 versus 2.1%, respectively, death in 0.9 versus 1.0%, and stent thrombosis in 0 versus 0.6% (all p > 0.05). After 24 ± 15 months, unadjusted rates of MACE were 17.7 versus 16.4%, with death in 2.7 versus 4.9%, myocardial infarction in 4.4 versus 3.7%, TLR in 15.0 versus 12.3%, and stent thrombosis in 3.1 versus 2.7% (all p > 0.05). Even at multivariable Cox proportional hazard analysis with propensity score adjustment, IVUS was not associated with any statistically significant impact on the risk of MACE, death, myocardial infarction, TLR (neither on the main branch nor on the side branch), or stent thrombosis (all p > 0.05). CONCLUSIONS: Despite a sound rationale to choose stent size, optimize stent expansion and guide kissing inflation, IVUS usage during PCI for coronary bifurcation lesions was not associated with significant clinical benefits in this large retrospective study.
Authors: Giuseppe Biondi-Zoccai; Imad Sheiban; Claudio Moretti; Tullio Palmerini; Antonio Marzocchi; Davide Capodanno; Corrado Tamburino; Massimo Margheri; Giuseppe Vecchi; Giuseppe Sangiorgi; Andrea Santarelli; Antonio L Bartorelli; Carlo Briguori; Luigi Vignali; Francesco di Pede; Angelo Ramondo; Massimo Medda; Marco de Carlo; Giovanni Falsini; Alberto Benassi; Cataldo Palmieri; Vincenzo Filippone; Diego Sangiorgi; Fabio Barlocco; Stefano de Servi Journal: Clin Res Cardiol Date: 2010-12-03 Impact factor: 5.460
Authors: Giuseppe G L Biondi-Zoccai; Elena Giraudi; Claudio Moretti; Filippo Sciuto; Pierluigi Omedè; Dario Sillano; Paolo Garrone; Gian Paolo Trevi; Imad Sheiban Journal: Clin Res Cardiol Date: 2010-01-03 Impact factor: 5.460
Authors: Christoph Stettler; Simon Wandel; Sabin Allemann; Adnan Kastrati; Marie Claude Morice; Albert Schömig; Matthias E Pfisterer; Gregg W Stone; Martin B Leon; José Suarez de Lezo; Jean-Jacques Goy; Seung-Jung Park; Manel Sabaté; Maarten J Suttorp; Henning Kelbaek; Christian Spaulding; Maurizio Menichelli; Paul Vermeersch; Maurits T Dirksen; Pavel Cervinka; Anna Sonia Petronio; Alain J Nordmann; Peter Diem; Bernhard Meier; Marcel Zwahlen; Stephan Reichenbach; Sven Trelle; Stephan Windecker; Peter Jüni Journal: Lancet Date: 2007-09-15 Impact factor: 79.321
Authors: Probal Roy; Daniel H Steinberg; Steven J Sushinsky; Teruo Okabe; Tina L Pinto Slottow; Kimberly Kaneshige; Zhenyi Xue; Lowell F Satler; Kenneth M Kent; William O Suddath; Augusto D Pichard; Neil J Weissman; Joseph Lindsay; Ron Waksman Journal: Eur Heart J Date: 2008-06-11 Impact factor: 29.983
Authors: Alessandro Alberti; Pietro Giudice; Alessandra Gelera; Luca Stefanini; Virginia Priest; Michael Simmonds; Christa Lee; Matthew Wasserman Journal: Eur J Health Econ Date: 2015-02-11
Authors: I Akin; C Naber; G Sabin; M Hochadel; J Senges; K H Kuck; C Nienaber; G Richardt; Ralph Tölg Journal: Clin Res Cardiol Date: 2013-05-17 Impact factor: 5.460
Authors: Eva S Kehmeier; Wolfgang Lepper; Martina Kropp; Christian Heiss; Ulrike Hendgen-Cotta; Jan Balzer; Mirja Neizel; Christian Meyer; Marc W Merx; Pablo E Verde; Christian Ohmann; Gerd Heusch; Malte Kelm; Tienush Rassaf Journal: Clin Res Cardiol Date: 2012-05-06 Impact factor: 5.460
Authors: Lucas Lodi-Junqueira; Marcos Roberto de Sousa; Leonardo Carvalho da Paixão; Silvana Márcia Bruschi Kelles; Carlos Faria Santos Amaral; Antonio L Ribeiro Journal: Syst Rev Date: 2012-09-21