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Randomized Comparison of Clinical Outcomes Between Intravascular Ultrasound and Angiography-Guided Drug-Eluting Stent Implantation for Long Coronary Artery Stenoses

Authors
 Jung-Sun Kim  ;  Tae-Soo Kang  ;  Gary S. Mintz  ;  Byoung-Eun Park  ;  Dong-Ho Shin  ;  Byeong-Keuk Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Yangsoo Jang  ;  Myeong-Ki Hong 
Citation
 JACC-CARDIOVASCULAR INTERVENTIONS, Vol.6(4) : 369-376, 2013 
Journal Title
 JACC-CARDIOVASCULAR INTERVENTIONS 
ISSN
 1936-8798 
Issue Date
2013
MeSH
Aged ; Chi-Square Distribution ; Coronary Angiography* ; Coronary Stenosis/diagnostic imaging ; Coronary Stenosis/mortality ; Coronary Stenosis/therapy* ; Coronary Thrombosis/etiology ; Disease-Free Survival ; Drug-Eluting Stents* ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Percutaneous Coronary Intervention/adverse effects ; Percutaneous Coronary Intervention/instrumentation* ; Percutaneous Coronary Intervention/mortality ; Predictive Value of Tests ; Prospective Studies ; Prosthesis Design ; Republic of Korea ; Risk Factors ; Time Factors ; Treatment Outcome ; Ultrasonography, Interventional*
Keywords
coronary artery disease ; drug-eluting stent ; intravascular ultrasound
Abstract
OBJECTIVES: This study sought to assess the impact of intravascular ultrasound (IVUS) guidance on clinical outcomes following drug-eluting stent implantation when treating long lesions. BACKGROUND: The role of IVUS guidance when treating long lesions has been tested during bare-metal stent, but not during drug-eluting stent, implantation. METHODS: A total of 543 patients treated with stents ≥ 28 mm in length were randomly assigned to IVUS guidance (n = 269) versus angiography guidance (n = 274). The primary endpoint was a composite of major adverse cardiac events (MACE), including cardiovascular death, myocardial infarction, target vessel revascularization, or stent thrombosis at 1 year following intervention. RESULTS: In the intention-to-treat analysis, total stent length was 32.4 mm in the IVUS-guided arm versus 32.3 mm in angiography-guided arm (p = 0.84). Adjunct post-dilation was more frequently performed in the IVUS-guided arm (54.6% vs. 44.5%, p = 0.03); post-intervention minimal lumen diameters were similar (2.55 vs. 2.55 mm, respectively, p = 0.50); and MACE occurred in 12 (4.5%) patients in IVUS-guided arm and in 20 (7.3%) patients in the angiography-guided arm (p = 0.16). However, among the 269 patients assigned to IVUS guidance, IVUS was not used in 13 patients (4.8%); conversely, in 274 patients assigned to angiography alone, 41 patients (15.0%) were treated with IVUS guidance. Therefore, in a per-protocol analysis according to actual IVUS usage, minimum lumen diameter was larger (2.58 vs. 2.51 mm, p = 0.04), and MACE rates were lower: 4.0% in the IVUS-guided arm versus 8.1% in the angiography-guided arm (p = 0.048). CONCLUSIONS: A strategy of routine IVUS for drug-eluting stent implantation in long lesions did not improve the 1-year MACE rates. The IVUS use per operator decision was associated with improved results. (A New Strategy Regarding Discontinuation of Dual Antiplatelet; NCT01145079).
Full Text
http://www.sciencedirect.com/science/article/pii/S1936879813004329
DOI
10.1016/j.jcin.2012.11.009
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Shin, Dong Ho(신동호) ORCID logo https://orcid.org/0000-0002-7874-5542
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/86819
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