Long-term events after intravascular ultrasound-vs non-intravascular ultrasound-guided percutaneous intervention.
Curtis R, Lee D, Garratt K, and Rowe S. Long-term events after intravascular ultrasound-vs non-intravascular ultrasound-guided percutaneous intervention. Catheter Cardiovasc Interv 2017; 89:S93-S94.
Catheter Cardiovasc Interventions
Background: Intravascular ultrasound (IVUS) has been used to quantitate coronary artery disease burden, understand lesion morphology, and optimize PCI. Numerous trials have investigated the impact of IVUS on outcomes after coronary intervention. In this study, demographic features, lesion and procedural characteristics, as well as longterm outcomes were evaluated in real world patients with and without IVUS-guided PCI. Methods: A total of 4173 patients from the TAXUS Liberté postapproval study were evaluated. Outcomes evaluated at 3 years included major adverse cerebral and cardiac events (cardiac death, myocardial infarction [MI], target vessel revascularization [TVR]) as well as major bleeding, and stent thrombosis. Analysis was done through 1:1 propensity match due to the non-IVUS group having a higher number of patients. Results: Out of the 4173 patients, IVUS was utilized in 360 patients. It was utilized in 8.8% of lesions and in 8.5% of vessels. MACE at 3 years occurred in 83 patients (27.7%) undergoing IVUS-guided and in 63 patients (21.1%) undergoing angiography-guided stent implantation (p=0.06). Cardiac death in the IVUS group occurred in 12 patients (5.0%) and 10 patients (4.0%) with non-IVUS guided PCI (p=0.57). The TVR rate in IVUS vs non-IVUS cohorts was 23.2% and 18.9%, respectively (p=0.20). Conclusion: In our real world application, the IVUS demonstrated no significant 3 year difference in all-cause death, MI, major bleeding, or early and late stent thrombosis when compared to the non-IVUS group. IVUS was used in less than 10% of patients. Specifically, it was underutilized in complicated lesions such as: left main, ostial, re-stenotic lesions, and long lesions. In less complicated lesions, IVUS did not significantly alter the outcomes at 3 years when compared to non-IVUS guided coronary intervention. Events tended to be more frequent in the IVUS group though it was underutilized in high risk lesions. Further evaluation is needed to assess the long-term outcomes where IVUS is appropriately utilized in complicated lesions. (Figure Presented).