IVUS / Park SJ

Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis.

Park SJ, Kim YH, Park DW, Lee SW, Kim WJ, Suh J, Yun SC, Lee CW, Hong MK, Lee JH, Park SW; MAIN-COMPARE Investigators.

Circ Cardiovasc Intery. 2009 Jun;2(3):167-77.

OBJECTIVES:

The aim is to determine the impact of intravascular ultrasound (IVUS) guidance in stenting for unprotected left main coronary artery stenosis on long-term mortality.

METHODS:

• 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.

SUMMARY:

• 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.

CONCLUSIONS:

Using a large registry, it was found that long-term mortality after unprotected LMCA stenting was reduced by IVUS guidance as compared with conventional angiography guidance. This result indicates that the routine use of IVUS is generally recommended while performing elective PCI for unprotected LMCA stenosis.

PARK SJ ARTICLE SUMMARY ( DOWNLOAD PDF )

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