CLINICAL: IVUS Clinical Paper Summaries

IVUS / Park SJ

• 975 patients
• 12 Korean centers
• Patients with unprotected left main coronary artery stenosis in a hemodynamic-ally stable condition
• Elective stenting under the guidance of IVUS (756 patients) or conventional angiography (219 patients
• Patients with acute myocardial infarction were excluded
• The 3-year outcomes between the 2 groups were primarily compared using propensity-score matching in the entire and separate populations according to stent type.

• In 201 matched pairs of the overall population, there was a tendency of lower risk of 3-year morality with IVUS guidance compared with angiography guidance (6.0 % vs. 13.6 %, log-rank P = 0.063; hazard ratio = 0.54; 95 % CI = 0.28 to 1.03; Cox-model P = 0.061).
• In particular, in 145 matched pairs of patients receiving drug-eluting stents, the 3-year incidence of mortality was lower with IVUS guidance as compared with angiography guidance (4.7 % vs. 16.0 %, log-rank P = 0.048; hazard ratio = 0.39; 95 % CI = 0.15 to 1.02; Cox model P = 0.055).
• In contrast, the use of IVUS guidance did not reduce the risk of mortality in 47 matched pairs of patients receiving bare-metal stent (8.6 % vs. 10.8 %, log-rank P = 0.35; hazard ratio = 0.59; 95 % CI = 0.18 to 1.91; Cox model P = 0.38).
• The risk of myocardial infarction or target vessel revascularization was not associated with the use of IVUS guidance.