Effect of Intravascular Ultrasound–Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation
| Autor: | Sung-Jin, Hong, Byeong-Keuk, Kim, Dong-Ho, Shin, Chung-Mo, Nam, Jung-Sun, Kim, Young-Guk, Ko, Donghoon, Choi, Tae-Soo, Kang, Woong-Chol, Kang, Ae-Young, Her, Yong Hoon, Kim, Yonghoon, Kim, Seung-Ho, Hur, Bum-Kee, Hong, Hyuckmoon, Kwon, Yangsoo, Jang, Myeong-Ki, Hong, Sang-Wook, Lim |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Coronary Angiography Radiography Interventional Lower risk law.invention Prosthesis Implantation Randomized controlled trial law Internal medicine Multicenter trial Outcome Assessment Health Care Coronary stent Intravascular ultrasound medicine Humans Everolimus cardiovascular diseases Myocardial infarction Ultrasonography Interventional Aged medicine.diagnostic_test business.industry Endovascular Procedures Percutaneous coronary intervention Stent Drug-Eluting Stents General Medicine Middle Aged equipment and supplies medicine.disease Surgery Cardiology Female business Immunosuppressive Agents Follow-Up Studies |
| Zdroj: | JAMA. 314:2155 |
| ISSN: | 0098-7484 |
| DOI: | 10.1001/jama.2015.15454 |
| Popis: | Importance Use of intravascular ultrasound (IVUS) promotes better clinical outcomes for coronary intervention in complex coronary lesions. However, randomized data demonstrating the clinical usefulness of IVUS are limited for lesions treated with drug-eluting stents. Objective To determine whether the long-term clinical outcomes with IVUS-guided drug-eluting stent implantation are superior to those with angiography-guided implantation in patients with long coronary lesions. Design, Setting, and Participants The Impact of Intravascular Ultrasound Guidance on Outcomes of Xience Prime Stents in Long Lesions (IVUS-XPL) randomized, multicenter trial was conducted in 1400 patients with long coronary lesions (implanted stent ≥28 mm in length) between October 2010 and July 2014 at 20 centers in Korea. Interventions Patients were randomly assigned to receive IVUS-guided (n = 700) or angiography-guided (n = 700) everolimus-eluting stent implantation. Main Outcomes and Measures Primary outcome measure was the composite of major adverse cardiac events, including cardiac death, target lesion-related myocardial infarction, or ischemia-driven target lesion revascularization at 1 year, analyzed by intention-to-treat. Results One-year follow-up was complete in 1323 patients (94.5%). Major adverse cardiac events at 1 year occurred in 19 patients (2.9%) undergoing IVUS-guided and in 39 patients (5.8%) undergoing angiography-guided stent implantation (absolute difference, −2.97% [95% CI, −5.14% to −0.79%]) (hazard ratio [HR], 0.48 [95% CI, 0.28 to 0.83], P = .007). The difference was driven by a lower risk of ischemia-driven target lesion revascularization in patients undergoing IVUS-guided (17 [2.5%]) compared with angiography-guided (33 [5.0%]) stent implantation (HR, 0.51 [95% CI, 0.28 to 0.91], P = .02). Cardiac death and target lesion–related myocardial infarction were not significantly different between the 2 groups. For cardiac death, there were 3 patients (0.4%) in the IVUS-guided group and 5 patients (0.7%) in the angiography-guided group (HR, 0.60 [95% CI, 0.14 to 2.52], P = .48). Target lesion–related myocardial infarction occurred in 1 patient (0.1%) in the angiography-guided stent implantation group ( P = .32). Conclusions and Relevance Among patients requiring long coronary stent implantation, the use of IVUS-guided everolimus-eluting stent implantation, compared with angiography-guided stent implantation, resulted in a significantly lower rate of the composite of major adverse cardiac events at 1 year. These differences were primarily due to lower risk of target lesion revascularization. Trial Registration clinicaltrials.gov Identifier:NCT01308281 |
| Databáze: | OpenAIRE |
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