Korean Circ J.  2013 Apr;43(4):231-238. 10.4070/kcj.2013.43.4.231.

Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Improves the Clinical Outcome in Patients Undergoing Multiple Overlapping Drug-Eluting Stents Implantation

• Ahn SG
• Yoon J
• Sung JK
• Lee JH
• Lee JW
• Youn YJ
• Ahn MS
• Kim JY
• Yoo BS
• Lee SH
• Choe KH

• KMID: 2224945
• DOI: http://doi.org/10.4070/kcj.2013.43.4.231

Abstract

BACKGROUND AND OBJECTIVES
Stented segment length is a predictive factor for restenosis and stent thrombosis still in the drug-eluting stent (DES) era, and the benefit of routine intravascular ultrasound (IVUS) is still unclear. The aim of the present study was to investigate whether IVUS-guided percutaneous coronary intervention (PCI) improved the vascular outcomes as compared with conventional PCI in the treatment of diffuse coronary artery disease.
SUBJECTS AND METHODS
From our registry database from January 2006 to May 2009, we identified 85 consecutive patients with de novo coronary lesions treated with at least 64 mm of multiple, overlapping DES. The 2-year rate of major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, non-fatal myocardial infarction, target lesion revascularization (TLR), or stent thrombosis, was compared according to the use of IVUS.
RESULTS
The 2-year MACE rate was lower in the IVUS-guided group than that of the angiography-guided group (8% vs. 33.3%, p=0.005). The incidence of TLR was lower in patients with IVUS use than in those without IVUS use (0% vs. 27.8%, p<0.001). On Cox proportional hazard analysis, no IVUS use {hazard ratio (HR) 5.917, 95% confidence interval (CI) 1.037-33.770, p=0.045} and age (HR 1.097, 95% CI 1.006-1.138, p=0.032) were unfavorable predictors for the 2-year MACE.
CONCLUSION
The use of IVUS may improve the effectiveness and safety of multiple overlapping drug-eluting stenting for long, diffuse coronary lesions.

Keyword

Intravascular ultrasonography; Coronary stenosis; Drug-eluting stents; Percutaneous coronary intervention; Thrombosis

MeSH Terms

Coronary Stenosis
Coronary Vessels
Drug-Eluting Stents
Humans
Incidence
Myocardial Infarction
Percutaneous Coronary Intervention
Stents
Thrombosis
Ultrasonography, Interventional

Figure

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  Fig. 1 Cumulative frequency distribution curves for analysis segment percent diameter stenosis. At 9 months, the reduction in mean percent diameter stenosis for the IVUS-guided group relative to the angiography-guided group was -35.9% (95% confidence interval, -21.4% to -50.3%; p<0.001). IVUS: intravascular ultrasound.

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  Fig. 2 Kaplan-Meier event-free 2-year survival curves for the composite of cardiovascular death, myocardial infarction, target-lesion revascularization, and stent thrombosis in the intravascular ultrasound (IVUS) and no IVUS groups. The 2-year event rate was lower in the IVUS-guided group than that of the angiography-guided group (8% vs. 33.3%, p=0.003).

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