Clinical Impact of Intravascular Ultrasound Guidance in Drug-Eluting Stent Implantation for Unprotected Left Main Coronary Disease
| Autor: | Federico Gimeno de Carlos, Fernando Alfonso Manterola, Felipe Hernández, Angel Sanchez Recalde, Javier Zueco Gil, José Antonio Baz Alonso, Manuel Jiménez Navarro, María José Pérez-Vizcayno, Eduardo Pinar Bermudez, Ivus-Tronco-Icp Spanish study, Tamara Garcia Camarero, Agustín Albarrán Gonzalez-Trevilla, José M. de la Torre Hernández, Armando Pérez de Prado, Íñigo Lozano Martínez-Luengas, Ángel Cequier Fillat, Gerard Roura Ferrer, Josep Gomez Lara, Jose Antonio Fernandez Diaz, Josepa Mauri Ferre |
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| Rok vydání: | 2014 |
| Předmět: |
education.field_of_study
medicine.medical_specialty medicine.diagnostic_test business.industry medicine.medical_treatment Population Hazard ratio Percutaneous coronary intervention equipment and supplies Revascularization medicine.disease Confidence interval surgical procedures operative Drug-eluting stent Internal medicine Intravascular ultrasound cardiovascular system Cardiology Medicine cardiovascular diseases Myocardial infarction Radiology business education Cardiology and Cardiovascular Medicine |
| Zdroj: | JACC: Cardiovascular Interventions. 7(3):244-254 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2013.09.014 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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