Validation of Intravascular Ultrasound- Defined Optimal Stent Expansion Criteria for Favorable 1-Year Clinical Outcomes

Abstract

BACKGROUND Robust evidence on optimal stent expansion using intravascular ultrasound (IVUS) is still lacking. OBJECTIVES The aim of this study was to validate the impact of different criteria for IVUS-defined optimal stent expansion on 1-year clinical outcomes after percutaneous coronary intervention (PCI). METHODS Individual patient data from 3 randomized trials were aggregated for this analysis. Patients (n = 6,290) were classified into 3 groups: optimized PCI by IVUS, nonoptimized PCI by IVUS, and angiography-guided PCI. The primary endpoint was target vessel failure (TVF) at 1 year, a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization. RESULTS Angiography-guided PCI was performed in 3,208 patients. Optimal stent expansion was evaluated in 3,082 patients with IVUS-guided PCI. For the absolute criterion of minimal stent area (MSA) >5.5 mm2 indicating optimal stent expansion, the optimized PCI group had a lower incidence of TVF (1.45% vs 3.86% vs 5.07%) compared with the nonoptimized PCI group (adjusted HR: 0.45; 95% CI: 0.26-0.75; P = 0.002) and the angiography-guided PCI group (adjusted HR: 0.35; 95% CI: 0.22-0.54; P < 0.001). Relative criteria did not show a significantly different TVF incidence between the optimized and nonoptimized PCI groups. In particular, the absolute criterion of MSA >5.5 mm2 was associated with a significant reduction of the composite of cardiac death or target vessel myocardial infarction (0.54% in the optimized PCI group vs 1.59% in the nonoptimized PCI group; adjusted HR: 0.39; 95% CI: 0.17-0.91; P = 0.028). CONCLUSIONS Post-PCI stent expansion meeting an absolute criterion of MSA >5.5 mm2 was associated with the most favorable clinical outcomes. (Effect of Intravascular Ultrasound in Patients Receiving Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents: An Individual Patient Data Meta-Analysis of IVUS-XPL, ULTIMATE and IVUS-ACS Randomized Trials; CRD42024559794) (JACC Cardiovasc Interv. 2025;18:2197-2205) (c) 2025 by the American College of Cardiology Foundation.