Jose M de la Torre Hernandez1, José A Baz Alonso2, Joan A Gómez Hospital3, Fernando Alfonso Manterola4, Tamara Garcia Camarero5, Federico Gimeno de Carlos6, Gerard Roura Ferrer3, Angel Sanchez Recalde7, Iñigo Lozano Martínez-Luengas8, Josep Gomez Lara3, Felipe Hernandez Hernandez9, María J Pérez-Vizcayno4, Angel Cequier Fillat3, Armando Perez de Prado10, Agustín Albarrán Gonzalez-Trevilla9, Manuel F Jimenez Navarro11, Josepa Mauri Ferre12, Jose A Fernandez Diaz13, Eduardo Pinar Bermudez14, Javier Zueco Gil5. 1. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Marques de Valdecilla, Santander, Spain. Electronic address: he1thj@humv.es. 2. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Meixoeiro, Vigo, Spain. 3. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Bellvitge, Barcelona, Spain. 4. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clinico San Carlos, Madrid, Spain. 5. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Marques de Valdecilla, Santander, Spain. 6. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Valladolid, Valladolid, Spain. 7. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital La Paz, Madrid, Spain. 8. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Central de Asturias, Oviedo, Spain. 9. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain. 10. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Leon, Leon, Spain. 11. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Virgen de la Victoria, Malaga, Spain. 12. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Germans Trias i Pujol, Badalona, Spain. 13. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Puerta de Hierro, Madrid, Spain. 14. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Virgen de la Arrixaca, Murcia, Spain.
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.
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.
Authors: Harsha S Nagarajarao; Chandra P Ojha; Venkatachalam Mulukutla; Ahmed Ibrahim; Adriana C Mares; Timir K Paul Journal: Curr Cardiol Rep Date: 2020-02-08 Impact factor: 2.931